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Revisional Bariatric Surgery

Sometimes bariatric surgery may fail and may not give the patients their desired weight loss.

Usually it is due to many factors. We will need to address those issues by going through the dietary history, psychology evaluation and go through non-surgical weight loss program that the insurance company will require. If it is established that the recurrence of the medical issues posses a more serious problem because of the obesity, then a revisional procedure may be indicated.

Failed Lap-Band:

Sometimes the problem may be from Slippage, and this can be corrected by moving the band to a higher location and by placing more stabilizing sutures to prevent it from slipping again. Some patients are Intolerant to thee Lap-Band and cannot get used to the restrictive way of eating.

Some feel that their weight loss is inadequate. In these situations, redo may be in the form of converting to another kind of bariatric procedure. The Lap-Band can be removed safely, and a Roux-en-Y Gastric Bypass or Sleeve Gastrectomy may be performed depends on the insurance coverage.

Failed Roux-en-Y Gastric Bypass:

Gastric bypass can also fail. There are situations that can cause failures. The most frequent is the dilatation of the stoma. We intentionally made the opening of the pouch to the small intestine small to give the patients their restriction with their food intake. However with the passage of time, this opening can enlarge, and the patient may lose their sense of restriction. Pouch dilatation can also play a role to allow the patient eat more. When this occurs, weight regain may become a problem.

Revisional or Redo surgery usually addresses those issues and we try to correct them. A Distal Roux-en-Y Gastric Bypass, which is a more malabsorptive operation may also be considered. A Band over the Bypass, which is placing a Lap-Band above the pouch has also been advocated. Redo surgeries are usually more difficult, and they do carry a higher complication rate.

Sometimes redo is necessary because the patient lost too much weight or is malnourished because of Stricture of the Stoma. This opening can be made larger by endoscopic balloon treatment through the mouth. However sometimes surgery may be the more definitive choice.Too much Malabsorption may sometimes need to be corrected y bypassing less of the small intestines.

Failed Sleeve Gastrectomy:

When the patient loses their restriction after sleeve gastrectomy, usually it’s due to Dilatation of the banana shaped stomach. This can be made thinner or re-sleeved, or converting to another bariatric procedure, like the Roux-en-Y Gastric Bypass or to a Duodenal Switch.

Failed Vertical Banded Gastroplasty (VBG):

VBG depends on the small pouch and the banded outlet to work. Both can Dilate and enlarge. When that occurs, weight regain may become problematic. Redo of the pouch and the outlet may correct the problem. Lap-Band over the VBG has been chosen by some patients, if they could demonstrate that purely restrictive procedure worked for them in the past. Most prefer to conversion to a Roux-en-Y Gastric Bypass.

Staple Line Disruption of the VBG used to be a major problem. Since we started to completely divide the staple line, that problem has become very rare. Re-stapling of the VBG is also achieved laparoscopically. Stricture of the Outlet is usually managed by endoscopic balloon therapy. Occasionally redo of the outlet may be needed surgically because of malnutrition.