Three Steps to Consider for a Weight Loss Surgery RevisionNovember 9, 2020
What to Expect with a Weight Loss Surgery Revision
Approaching weight loss when you have already had a weight loss surgery procedure can be daunting. Not to mention the constant new evolving techniques, one can find themselves lost when they find that their history precludes them from certain procedures.
When you had your procedure, having to have a weight loss surgery revision probably didn’t cross your mind.
Many patients find themselves uncomfortable from the get-go and worry about a stigma of feeling like they’ve “failed” if they return to their bariatric surgeon. Patients can feel they have an expectation to uphold leading them to withdraw from assistance or professional help.
The bottom line for "failing" at your surgery is that seeking help is nothing to be ashamed of. There is a starting point available to everyone. The key is taking hold of your current situation.
Before considering revisional surgery, it is important to assess your current diet and eating patterns. Many times, supervised medical assistance can give you the tools to get back on track allowing you to potentially avoid revisional surgery altogether.
There are a number of reasons patients regain weight and evaluating your specific situation and stressors is crucial. Taking hold of these factors is a vital first step so that when we do begin our path towards a revisional procedure, we have achievable goals in place.
While professional assistance is the best way to determine the procedure that is right for you, I like to consider three main steps in this process for patients that are in a helpless spiral towards continuing to regain towards their initial pre-operative weight.
Three Steps to Consider for a Weight Loss Surgery Revision
STEP 1: Halt Any Further Weight Regain
This may sound simple but the first step is realizing that weight regain is the norm following virtually any type of weight loss.
The first step for any patient who has regained weight following a weight loss procedure is to completely halt any further weight gain. While less common after bariatric surgery, a number of patients will regain weight months to years after their initial surgery. Several factors lead to weight regain including life stressors, changes in behavioral patterns and eating habits, anatomical changes, and appetite resurgence.
The National Weight Control Registry is a research database of over 10,000 members that have lost at least 30 pounds of weight and have kept it off for at least one year. Using this registry, we have been able to identify key features necessary to prevent this.1
By and large, the most important component is physical activity. The overwhelming majority of individuals who exercise regularly at least 45-60 minutes daily at a moderate intensity successfully keep their weight off at long-term intervals.
Often times, when we look at your history of weight loss after your initial surgery, we can identify specific activities you used to lose weight. Reintroducing anything you have recently stopped can be an important first step. Pay attention specifically to those activities you enjoy as you will find yourself sticking with them for longer.
Another key insight is the importance of self-monitoring, individuals that successfully maintain their weight check it on a scale at least once a week. Find a place where you can check your weight regularly.
Often forgotten is the importance of eating breakfast daily, this will help you to regulate your diet and your metabolism to keep your body constantly burning calories.
Finally, reducing television time is also associated with individuals maintaining their weight which comes as no surprise. Minimize mindless screen time and find activities that engage both your mind and body.
STEP 2: Review the Initial Procedure
The second step which becomes especially important as we begin to talk about interventional options is to take a close look at your body and more specifically your stomach from the initial procedure.
Some of the most common revisional surgeries we perform are for patients that have had a laparoscopic gastric band. The lap-band was a common weight loss procedure utilized in the last 20 years that involved placing a silicone implant around the top portion of the stomach.
This band can be inflated to reduce food intake. In patients that have had a lap band, we have the option of removing this and performing a revision to either a sleeve gastrectomy or a gastric bypass.
In patients that have already had a sleeve gastrectomy or a gastric bypass, our first step is to look at the shape and size of your existing stomach. This is best accomplished by an endoscopy where a camera can be inserted to directly visualize the stomach and esophagus. After a thorough endoscopy, your bariatric surgeon will be able to tell you the current state of your stomach.
Sometimes if a gastric sleeve is widened or there is a redundant area of the top portion of the stomach, a re-sleeve surgical procedure can be performed. Other times, especially if a patient has coincident reflux, a conversion to gastric bypass would be the best option. For other patients, a duodenal switch may be considered especially for patients with higher BMIs due to the greater amount of malabsorption present.
Patients that have already had a gastric bypass can most commonly undergo correction to reduce the size of their stomach pouch or the size of their stomach opening, known as the gastrojejunostomy. This can be accomplished either surgically or endoscopically. A Lap-Band can also be used in selected patients to restrict the emptying of their gastric pouch.
STEP 3: Formulate a Plan Customized for You
The third and final step after examining the different options available is to formulate a comprehensive plan that will suit your individual needs.
In addition to the surgical revision, a big part of successful weight loss will be returning to successful physical activity habits and diet patterns. Meeting with a nutritionist is an important step that should take place prior to your surgical procedure. Creating a detailed plan of action prior to your revision will help ensure you stay on track throughout the process.
The most significant insight we have gained when studying patients that have undergone revisional procedures for weight loss is the weight loss journey will ultimately be more difficult and require more work.
Patients undergoing a second bariatric procedure will generally lose less weight than they did compared to their index primary weight-loss procedure. However, the primary point to keep in mind here is your mindset. While this could be perceived as a potential obstacle, the patients who achieve success often use this as a motivating factor. Further, your prior experience with initial weight loss and previous successes are now a tool for you to look upon as we aim for your renewed success once and for all.
- National Weight Control Registry - Thomas JG, Bond DS, Phelan S, Hill JO, Wing RR. Weight-loss maintenance for 10 years in the National Weight Control Registry. American Journal of Preventive Medicine, 46, 1, 17-23.
ABOUT THE AUTHORDr. Nirav Desai MD, completed his General Surgery Residency at Mount Sinai Beth Israel where he discovered his passion for minimally invasive GI surgery. Dr. Desai is certified with the American Board of Surgery, is Board-Certified in Board certification in Obesity Medicine, and is an active member of the American Society for Metabolic and Bariatric Surgery. He is proud to return to the New York area and serve Connecticut as a part of the New York Bariatric Group.