What is revisional weight loss surgery?

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Revisional weight loss surgery can mean many things. It may refer to someone who is having one type of weight loss surgery then switches to another. For example, lap band to sleeve or sleeve to gastric bypass.

There are also endoscopic revisional procedures. Revisional surgery is usually higher risk than the original procedure due to increased scarring on the inside of the stomach.

With the growing popularity of weight-loss surgery, there is greater need for revisional surgery to alter or repair one of the many types of surgical procedures for the treatment of morbid obesity.

The most common reason patients undergo gastric bypass revision is weight-related. Either not enough weight was lost following surgery, or too much was gained back. In some cases, there are medical complications that require revisional surgery.

Your surgeon will want to rule out diet or exercise problems before undertaking another procedure. Each revision must be tailored to meet the particular needs of the patient.

Revisional surgery may be an option for patients who have already undergone a procedure and need another one to either repair the first one, or for those who have gained weight or have not lost sufficient weight.

In about 50 percent of cases, vertical banded gastroplasty, or "stomach stapling" fails, resulting in inadequate weight loss. Staple erosion in more recent cases may cause chronic inflammation, ulcers, and infection. This is one major reason that our surgeon use absorbable sutures instead of staples to perform intestinal attachments to the stomach.

In other cases, a patient's original gastric bypass may become ineffective when the small pouch and opening to the intestine which the surgeon created stretches, allowing more food into the intestine, leading to weight gain. Such stretching of tissue may occur because of overeating, or from the healed tissue stretching naturally.

Sometimes scar tissue develops during the healing process after a first surgery which can make a revision surgery and healing more difficult. Our surgeons have created procedures that lower the risk of a second surgery.

Most often, patients need a revision surgery to convert an older weight-loss procedure to a more modern, effective one, such as the Roux-en-Y gastric bypass with a duodenal switch.

Bariatric revision surgery adapts a previous weight loss procedure to work better for the patient. In this video, Michael Snyder, MD, a bariatric surgeon at the Denver Center for Bariatric Surgery, explains how surgeons find out what works for you.

Dr. Melissa B. Bagloo, MD
Bariatric Medicine (Obesity Medicine) Specialist

The most common reason patients seek obesity surgery revisions is to convert an older weight loss procedure to a more modern and effective procedure such as the Roux-en-Y gastric bypass or duodenal switch (also known as bilio-pancreatic diversion with duodenal switch or DS).

There are several procedures that may be used if you need revision surgery for a previous weight loss procedure. These include:

  • Adjustable banded gastric bypass as a revision of gastric bypass. For patients who experience weight gain after gastric bypass, surgeons at the center have developed a procedure in which an adjustable band is placed on top of their bypass, allowing control of the size of the stretched tissue and offering the option to tighten the band in to prevent weight gain. This procedure may have less risk than other revisional options.

We also convert failed gastric bypass to duodenal switch.

  • Banded gastric bypass as a revision of gastric banding. If you originally had a gastric banding procedure, weight gain may occur if the band slips or if you have trouble tolerating the tightening of the band. Surgeons at the center can reposition the band, or they can add a gastric bypass, leaving the band in place, a procedure created by surgeons at the center. This allows doctors to operate on a fresh portion of the stomach rather than a scarred area, and save the adjustability of the band to enhance the overall results. Because the procedure does not involve stapling over scarring, it offers the effects of a bypass without the risks of revision surgery.

We also convert vertical banded gastroplasty into banded gastric bypass.

  • Endoscopic sclerotherapy. Another option your doctor may choose is to tighten tissue that has stretched following gastric bypass. This is accomplished by scarring the opening between the stomach pouch and the intestine through injection of an acidic solution (this technique is also known as sclerotherapy). The scarring narrows the opening, slowing the exit of food from the stomach pouch, and enabling patients to better restrict food intake. This procedure can be performed using a scope placed through the mouth, avoiding further incisions.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.