Reasons for Revision Bariatric Surgery

Inadequate Weight Loss and/or Weight Regain
Of the reasons to have revision bariatric surgery, inadequate weight loss and/or weight regain is the number one reason patients seek revision bariatric surgery. Not every patient is the "average" patient and therefore may not lose weight as a result of any one type of bariatric surgery the way an average patient would. Where one type of bariatric surgery meets the needs a particular patient, the same surgery may not meet the needs of another patient; of course there are reasons for this. 

  • A patient may not adapt well to the lifestyle required after a particular bariatric surgery. 
  • Perhaps a specific bariatric surgery does not address the metabolic needs of a patient. 
  • There are anatomical changes made to a patient's body during bariatric surgery and these changes are not always maintained. 

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:

  • the pouch may stretch and become larger
  • the outlet of a gastric pouch may increase in diameter 
  • a gastro-gastric fistula may form between the gastric pouch and the bypassed stomach
  • the intestine may increase its absorptive abilities beyond what was expected
  • restriction may decrease as a result of a band slippage 

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.

Unresolved Co-morbidities
Unsatisfactory resolution of co-morbidities after bariatric surgery is an additional reason a patient may consider revision or conversion bariatric surgery. Unsatisfactory resolution of co-morbidities is generally related to the factors causing metabolic failure, as unsatisfactory resolution of co-morbidities generally coincides with insufficient weight loss and co-morbidities are strongly associated with metabolism. Cases involving unsatisfactory resolution of co-morbidities, require a similar approach as cases of metabolic failure, usually requiring conversion of the failed bariatric procedure, to a more metabolically active bariatric surgery type. 

Medical Complications
As a result of bariatric surgery, some patients do have medical complications that must be treated with revision bariatric surgery. In some cases, treating medical complications with revision bariatric surgery will be similar to the treatments previously discussed for mechanical and metabolic failure, but others may require reversal of the original bariatric surgery while weight loss is preserved. Possible medical conditions requiring revision include the following:

  • ulcer
  • stricture
  • severe dumping
  • malnutrition
  • over-malabsorption
  • metabolic bone disease
  • iron deficiency/anemia
  • vitamin deficiency
  • vitamin-D deficiency
  • thiamine (vitamin B-1) deficiency.

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This information has been provided by Dr. John Husted. To learn more about Dr. Husted, please visit http://www.johnhustedmd.com/.