Failed Weight Loss Surgery 2

The Responsibility for a Failed Weight Loss Surgery Procedure, Part One

July 18, 2018

Obesity is a leading cause of morbidity, illness, and death in the United States. Obesity in adolescence is the fastest growing segment of the population. In the last 30 years, different surgical approaches have been tried as treatment options for obesity. These are in addition to non-surgical options, including medications, and commercially available “diet” and “exercise” plans.

Different matrixes can gauge the outcome of all forms of treatment. The goal(s) may be to achieve a healthy weight and BMI, resolve health conditions, reduce physical limitation of obesity, improve longevity, and others. All of this should be accomplished while mitigating the risk of creating new problems or condition. There is also the expectation that a treatment should provide the most benefit with the least risk involved.

When we evaluate a treatment, surgical or medical, we tend to overlook the long-term sequel of the treatment. In some cases, such as adjustable gastric banding, for years was promoted as the “least invasive,” “reversible,” and “outpatient.” However, the reality was these terms were only marketing tools for a procedure with a very poor long-term outcome, in terms of sustained weight loss, but also complications, which presented late.

Find out the details for each procedure.

Failed Weight Loss Surgery

We can look at weight loss surgical failures in terms of the lack of (1)-weight loss and weight regain, or (2)-complications. These may occur independently or together.

What I would not want to do is to assign blame on anyone. The reality, however, is that there is significant misinformation and unrealistic expectations presented when weight loss treatments are discussed.

Patients have the exceptions that a simple diet, pill, balloon or band can solve the disease of obesity.  Make no mistake there is no simple solution to the complex condition of obesity. There are a number of options with the individual benefits, side effects, and complications that one has to consider.

Unrealistic Expectations and Unachievable Results Promised

This is where I think the “Responsibility for a Failed Weight Loss Surgical Procedure” lays with unrealistic expectations on the patient’s part and unachievable results promised. To further complicate this, some patients will rely on “Dr. Google” and “Dr. Facebook” for second or third opinion (in some cases as the only opinion).

Websites such as as a platform(s), have a role of providing unbiased information backed by scientific information in addition to individual patient experiences. Critical to these sources of the information is the recognition that an individual patient’s experience may be unique and not reproducible or the norm. The patients should do their due diligence in choosing the best weight loss surgical procedure for their individual needs, health status and goals.

In order to begin to understand if anyone or anything is responsible for failed weight loss surgery, we need to know what are the causes of poor outcomes of weight regain, inadequate weight loss, recurrence or non-resolution of comorbidities, or onset of complications. The following table describes possible contributors to a particular failed weight loss procedure.

Causes of Weight Loss Surgical Failures in the Order of Possible Significance

Patient Surgery
AGB  E  P  A  D  F   P  C 
Gastric Bypass (RNY)  E  D  S  A   T  C  P 
Gastric Sleeve  E  D  A   C  T 
Duodenal Switch (DS)  S  D  A  F   C  T 
SIPS-SADI  E  D  A  S  F   C  T 
Gastric Balloon  E  F  D   C 

 A - Activity (An integral part of any healthy lifestyle, increase metabolic rate and building muscle mass)

 C - Complication (Complication of any surgical or medical treatment, i.e. hypertension with diet pills, leak with a surgical procedure)

 D - Diet (Healthy lifelong food selection are critical to lifelong weight management)

 E  - Expectation (What patients THINK the outcome a treatment is, may significantly differ from results documented by scientific data)

 F - Follow-up (Long-term follow up with the primary treating surgeon)

 P  - Procedure (choice of the different operations)

 T - Technical (Specific variations of a particular procedure, i.e. size of the pouch in RNY, the length of the common channel in DS, or bougie size in DS)

 S - Supplements (Vitamin and mineral supplements needed)

Failure of weight loss surgery may be defined in a number of ways such as weight regain, lack of weight loss, non-resolution of comorbid conditions, the onset of new complication are all forms of failed weight loss surgical procedure. The underlying responsibility cannot simply be placed on one party. The causes are multifactorial and complex.



Dr. Ara Keshishian is Director and Surgeon at Central Valley Bariatrics. He has performed more than 2,000 Duodenal Switch procedures and 500+ revisions from other procedures such as RNY, Lap-Band & VSG to the DS since 1999. He has published several research articles on weight loss surgery topics.
Read more articles from Dr. Keshishian!