Revision Weight Loss Surgery
Revision weight loss surgery is sometimes necessary and sometimes very beneficial to re-start the weight loss process. Over time, some patients with gastric pouches after gastric bypass (RYGB) or sleeve gastrectomy (SG) will feel that they can eat substantially more, and feel they have lost a sense of restriction.
Sometimes the pouch is larger on an upper GI Xray, done with Xrays after taking oral contrast. Sometimes the pouch looks the same but it no longer produces the restricted outflow it once did. Other times, rarely, new complications may have arisen, such as a fistula, or connection to the larger portion of the stomach.
With hundreds of thousands of Americans and millions of people worldwide having undergone weight loss surgery in the past years, more patients are seeking revisions years later. In the past the only options were to perform a type of open revision procedure, or to simply press on with nonsurgical efforts.
Times have changed. A number of revision options are available and successful. Most commonly, a stretched pouch can be surgically revised with a laparoscopic surgical technique. The goal is to create another, small, pouch, and re-establish the sense of restriction and satiety. Other times a laparoscopic adjustable gastric band (LAGB) can be placed over the prior surgery to create better restriction. These both work in many cases, though certainly not in every case.
Additionally, sometimes a procedure can be converted to a different type of surgery, such as converting a LAGB to a RYGB or biliopancreatic diversion (BDP).
Most recently, the use of Stomaphyx, an endoscopic technique performed with a scope passed down the throat, can be used to revise and tighten a stretched pouch. It advantage is that it is the least invasive procedure. Its disadvantage is that long term data are not available.
In sum, many options exist for a patient who has had weight loss surgery and is now re-gaining weight. A medically-supervised weight loss program, sometimes with the aid of prescription weight loss drugs, is often helpful. Re-dedication to the weight loss goals, renewed commitment to long term successful behaviors of shopping, eating, and exercise, are essential. And if surgery is being considered, a visit with an experienced bariatric surgeon who has performed many types of revision procedures is often very helpful. There are many good options available, and the goal of improved health and healthy weight loss are too important not to explore every option.