It is not uncommon for patients who have had bariatric surgery to relapse and regain the weight. In fact, statistics show that one in five people who undergo weight loss surgery regain weight within the first several years. Today we will be talking about bariatric revision surgery.
One would think that reducing the size of the stomach through weight loss surgery would ensure that the results are permanent. Unfortunately, it is not that easy and is a bit more complicated than that. Many factors can cause individuals to gain weight after bariatric surgery, and sometimes it’s simply because the surgery that was performed did not really fit the patient’s needs. To understand why we should take a look at how weight loss surgery works.
What Is Bariatric Surgery?
Bariatric surgery is a term used to describe one of several procedures that alter the digestive tract temporarily or permanently, and the altered state helps the patients lose weight by controlling the amount of food that can be ingested at one time, limiting the number of calories that are absorbed by the body, and helps control the feeling of being hungry.
Individuals who have a body mass index (BMI) of 40+ qualify for bariatric surgeries or procedures. Also, if a patient has a BMI of 35+ and has a weight-related health issue like type 2 diabetes, they would be a candidate for weight loss surgery.
Gaining Weight after Bariatric Surgery
Usually, patients who have bariatric surgery will see significant weight loss in the first several months. Much of this can be attributed to the smaller stomach size, the body having to heal from surgery, and the very restricted diet patients must follow. The human metabolism can speed up or slow down adapting to change as part of the body’s natural preservation ability.
The body may even alter the reconfigured stomach and digestive system after the surgery, or individuals may over-eat and stretch out their smaller stomach which allows them to continue to eat too much. If this happens and the stomach stretches, then most of the benefits of bariatric surgery will be ineffective.
These issues can cause weight regain or prevent a patient from losing weight in the first place causing them to seek out their doctor for a solution. Sometimes, the surgery previously performed causes unpleasant complications that the patient cannot tolerate so they go back to their doctor for help. Often, bariatric revision surgery is the answer and will help facilitate weight loss and alleviate unpleasant symptoms.
Revision Of Previous Weight Loss Surgery
Revisional weight loss surgery can repair areas that were altered during a previous bariatric procedure but have stretched out.
During all bariatric surgeries, the size of the stomach is made significantly smaller (into a pouch-like sleeve) to restrict the amount of food the patient can eat. Over time, this smaller stomach pouch can become stretched out from overeating, or sometimes it is a result of the body’s natural ability to heal and adapt to changes.
Once the stomach capacity has been increased, the patient is able to eat more, they do not feel full as fast, and do not stay satisfied as long. Weight loss revision surgery can be performed to correct the areas that have become stretched out and restore the restrictive properties of the original weight loss surgery.
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What Is Bariatric Revision Surgery?
Many people ask “Can you have bariatric surgery twice?”. If you have previously had bariatric weight loss surgery and have regained weight, finding diet and exercise are ineffective, you may be a candidate for bariatric revision surgery. Bariatric revision surgery would help correct any issues that have occurred since the initial surgery which are inhibiting further weight loss.
After undergoing bariatric surgery, patients usually remain under the care of their surgeon for several years. Depending on how much time has passed since your weight loss procedure, your original surgeon may still be monitoring your progress. If the surgeon feels your weight loss is inadequate they may take X-rays to see if your stomach has changed size or try to isolate what is going on and determine if you require a revision.
It may have been years since the initial surgery and you may have gained weight for a variety of reasons. Depending on the type of surgery you had initially, you may benefit from revision surgery. The revision options that would work best for you are going to depend upon your weight loss goals and the type of surgery you had previously.
Gastric Sleeve Revision Surgery
If you previously had gastric sleeve surgery and require a revision it can be performed through a technique called endoscopic sleeve gastroplasty (ESG). This procedure is performed endoscopically accessing the stomach via the throat and is an outpatient procedure. The gastric sleeve revision is done through sutures that reduce the stomach size without having to use incisions or requiring a hospital stay.
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Gastric Bypass Revision Surgery
If you have previously undergone gastric bypass surgery and require a revision the procedure is called a transoral gastric outlet reduction (TORe) and is used to repair or reconfigure the connection that links the stomach and small bowel.
Sometimes the surgeon can insert some sutures into the gastric outlet using an endoscope using zero incisions. After these stitches have been put in, patients get full faster so they stop eating and lose weight.
A gastric bypass revision performed endoscopically is an outpatient procedure and individuals can go home the same day with a fairly short recovery time.
Bariatric Revision Surgery FAQs
1. How Do They Do Weight Loss Revision Surgery?
Individuals who have either gained weight after bariatric surgery or whose weight loss has stalled despite their perseverance in their diet and exercise program sometimes need some help to initiate additional weight loss. There are a few different techniques surgeons can use to help these patients including:
- Further reducing the stomach size. This can usually be done using sutures endoscopically and does not require incisions;
- Tightening or resizing the stomach pouch that has been stretched out. This can be done through the use of sutures as listed above or sometimes can be accomplished using injections of sclerosant containing sodium morrhuate. These injections, given endoscopically, cause the stomach to shrink;
- Reducing the size of the connection between your stomach pouch and small intestine;
- Converting your surgery to a different type of procedure for example the gastric sleeve to a gastric bypass or a gastric bypass to a duodenal switch.
2. How Do You Qualify for Bariatric Revision Surgery?
If you are looking into bariatric revision surgery you should set up a consultation with your surgeon to see if you are eligible. Not everyone will be a qualified candidate for a bariatric revision procedure but some of the determining factors considered will be:
- The type of weight loss surgery that is being revised;
- If complications from the initial surgery are the reason for revision;
- Patients overall health and unique circumstances;
- The reasons for insufficient weight loss or causes of weight gain;
- In some cases, patients may need to provide psychological and nutritional assessment results.
3. How Many Weight Loss Surgeries Can a Person Have?
There is no set number of times an individual can undergo a bariatric weight loss procedure however, each will be determined on a case-by-case basis and there will be qualifying factors for each. An individual may or may not qualify for multiple procedures. A consultation with a surgeon would be necessary to determine if an individual would qualify for additional surgery or another procedure.
Choosing a bariatric specialist with a proven track record and selecting the best procedure for the patient initially will mitigate the risks of a future weight loss surgery revision.
Whether patients choose a surgical or non-surgical weight loss procedure to help promote weight loss, they will need to be committed to making the permanent lifestyle changes necessary to be successful.
4. Is Weight Loss Slower after Revision Surgery?
Patients will lose weight at their own rate; however, patients who have had revision surgery have reported that they lost weight at a slower rate after revision surgery than they did after their initial procedure. Patients have the potential to lose up to about 60 percent of their excess body weight after the revision.
5. How Long Is Bariatric Revision Surgery?
The length of the revision procedure will depend on the type of conversion being done. For instance, converting a gastric sleeve to a gastric bypass will take about 2.5 hours but repairing staple failure on a sleeve normally takes between 30-60 minutes.
6. How Successful Is Bariatric Revision Surgery?
Usually, the outcome of bariatric revision surgery is positive and patients are given relief from heartburn and acid reflux and begin to see significant weight reductions. Health issues that are related to obesity begin to dissipate and often patients can reduce their associated medications gradually under their doctor’s supervision.
Patients typically lose about 60 pounds for every 100 pounds they have in excess weight. Excess weight is calculated by subtracting the ideal or goal weight from the current weight.
7. Is Gastric Bypass Revision Surgery Safe?
Risks associated with a gastric bypass revision will vary by procedure and technique. Following the directions for aftercare, diet, and exercise provided by your surgeon after your initial weight loss procedure and avoiding a second surgery is the best course of action. Learn more about safe forms of weight loss surgery and which procedure may be right for you.
If you want to learn more about bariatric revision surgery and explore the options for your individual situation, contact IBI Healthcare Institute to schedule a personal consultation with our bariatric experts.