Revision Surgery After Gastric Bypass - What to Know
Enduring gastric bypass surgery only to come out of it with an undesired result or additional complications is hard on patients both physically and mentally. While this scenario does happen from time to time, revision surgery has proven to be a successful tool in helping patients achieve their preferred end result. Looking for more information? Here's what you should know.
The basics of gastric bypass surgery
For patients that have tried diet and exercise to no avail and have found they have health problems because of their weight, gastric bypass is an option. The surgeon will first create a small stomach pouch by dividing the top part of the stomach. Then the small intestine is divided with part of it connecting to the new smaller stomach pouch while the other half is connected further down.
The smaller stomach pouch only allows for the consumption of smaller meals meaning fewer calories consumed. The new digestive pattern changes hormones to suppress hunger and lets patients recognize when they're full. This type of surgery can account for significant long-term weight loss and a change in eating habits.
Who needs revision surgery?
After any type of bariatric surgery, patients may feel that the hard work is over, but it's actually just beginning. At around the six-month mark, patients can see weight loss at about 30%-40% of excess body weight. But sometimes, that's not always the case. The following may be some reasons to consider revision surgery.
- Inadequate weight-loss
- Excessive weight gain
- Complications like pain or acid reflux
- The wrong procedure is done the first time around
Gastric bypass patients are continually monitored by their doctors, so if any concerns arise, it's easier to try to correct them before becoming too serious. However, sometimes revision is necessary. Let's take a closer look at each of the reasons why revision surgery might be helpful.
Inadequate weight-loss or excessive weight gain
According to the National Center for Biotechnology Information, patients requiring revision surgery after gastric bypass is anywhere from 9%-17%. Many of those patients choose the surgery due to inadequate weight-loss in the first few years or an excessive weight-gain after the original surgery. Within the first year or two after gastric bypass, patients usually settle into their goal weight. That's not always the case, and some patients may require more time to achieve goal weight. Factors like exercise and overall nutrition are key to reaching the desired end result. However, sometimes weight-loss stalls completely, and no matter what the patient does, they can't seem to get the pounds off.
On the other end of the spectrum, if patients aren't careful with their diet and exercise plan, the pounds can easily creep back on. In the years after surgery, it's common for the stomach to stretch, allowing the patient to eat more and gain back unwanted weight. In both cases, after careful consideration, revision surgery may be necessary to help aid or correct weight problems.
Complications after gastric bypass
One of the more common complications after gastric bypass surgery is acid reflux. While the initial surgery creates a pouch to divert stomach acids away from the esophagus, there are some patients that present with reflux anyway. The roux limb, which is the new passageway created to take food to the intestine, may need lengthening if severe reflux occurs after the initial surgery.
A preliminary report shows that roux limb lengthening may also increase weight-loss as well as reducing the ill effects of acid reflux.
Incorrect procedure the first time around
Patients that initially had a gastric sleeve or band placement the first time around sometimes find they aren't losing the amount of weight they desire even with a strict food and exercise plan. Others may have physical pain due to band slippage or acid reflux and vomiting. Many times that first surgery wasn't the correct procedure for the patient. Instead of a gastric sleeve, the patient may have benefited more from gastric bypass. In these cases, revision surgery is necessary.
Types of revision surgery
If your doctor determines you meet the criteria for revision surgery after an initial gastric bypass, here are your options.
- Duodenal Switch — In this surgery, the duodenum, the first part of the small intestine is divided. The last part of the intestine, the distal, is connected to the smaller stomach. This results in food traveling down the new pathway to the end of the intestine and resulting in greater weight-loss. The duodenal switch has shown patients to have fewer food intolerances and lose more weight over a long-term period.
Outlook for patients needing revision surgery
As with any surgery, potential complications could arise. A recent study found that around 34% of patients experienced complications in the first few months after their revision surgery. Things like surgical site leakage, hernia development, and pneumonia were the most common. However, for patients that had revision surgery due to their stagnant weight-loss, on average most saw a loss of 68.9% excess body weight.
While these second revision operations may experience a higher risk, the decrease in overall body mass index and increase in weight loss may prove to be worth the risk.
Trust our team
Gastric bypass and other weight-loss surgeries are one of the most effective ways to sustain long-term weight loss. If you've experienced gastric bypass surgery and feel like you have more weight to lose or experience adverse side effects, it's time to consider revision surgery. We have a team of surgeons and medical staff that can help you decide upon the right course for your continued lifestyle change. Please contact us for more information regarding any questions about our revision surgeries.