Reasons for Revision Bariatric Surgery
Inadequate Weight Loss and/or Weight Regain
Bariatric surgery may fail for all of the above reasons.
It must first be established whether it is the patient who has failed the bariatric surgery, or the bariatric surgery that has failed the patient. Patients may not be properly educated on how to make their bariatric surgery work best for them. While ensuring proper education prior to bariatric surgery will help a patient achieve and maintain weight loss, adequate long term care and support may be all a patient needs to get "back on track." After a period weight regain however, it may be extremely difficult for a patient to lose the weight they have gained back.
Quite frequently, the bariatric surgery metabolically and/or mechanically fails the patient.
Mechanical failures are caused when the anatomical changes made during the original bariatric surgery, are not maintained. Examples of these changes are as follows:
Reconstructing the original anatomy created during the first bariatric surgery may work for the above cases, restoring the environment that allowed for weight loss initially. Re-trimming a dilated gastric bypass pouch or re-trimming a stretched-out vertical sleeve gastrectomy, are options for treating pouches that have stretched and enlarged. A suitable fix for a dilated outlet requires placing a band around a dilated gastric bypass outlet. It was previously suggested that deteriorated staple lines of gastroplasty procedures could be re-stapled, but due to the high long term failure rates of gastroplasty procedures, it is now recommended that gastroplasty procedures be converted to a different bariatric surgery type.
There are instances where bariatric surgery fails to meet the metabolic needs of patients.
Success after bariatric surgery involves more than just eating properly. A patients metabolism does influence weight loss/ weight maintenance. When patients fail after bariatric surgery for metabolic reasons, this is know as "Metabolic Failure." Where corrective procedures for mechanical failure of bariatric surgery attempt to restore the previous anatomy, correcting metabolic failure involves converting the patient to bariatric surgery type that is more metabolically active. A prime example of this would be to convert a Gastric Bypass to a Duodenal Switch instead of re-trimming the pouch.
This information has been provided by Dr. John Husted. To learn more about Dr. Husted, please visit http://www.johnhustedmd.com/.