Some people who have weight loss surgery do not lose sufficient weight or have weight regain years later. In such cases, these people may benefit from a revision weight loss surgery to help them lose weight and treat symptoms like acid reflux. In this article, we’ve rounded up the opinions of several leading bariatric surgeons who weigh-in on the benefits, risks, and options for revision weight loss surgery.
There are several reasons for inadequate weight loss or weight regain:
- Some people gain weight owing to changes in healthy habits, illness or injury, or major events in their lives.
- Other people may find their anatomy has changed over time and needs repair or their initial weight loss surgery was not properly done.
- In terms of the gastric band, these people may see peers achieving more weight loss with the gastric sleeve or gastric bypass. The average weight loss after surgery is gastric bypass 70%, the gastric sleeve 60%, and the gastric band 50% of excess weight that is lost.
Weight Gain Due to Lifestyle Changes
It is well-known that obesity is a chronic illness that cannot be cured by weight loss surgery. The success of any weight loss surgery, or revision weight loss surgery for that matter, depends upon our commitment and capability to stick to a healthy lifestyle and follow nutrition guidelines.
“The problem might be that you were not prepared appropriately before surgery to deal with the dietary and psychological changes that are required to maximize your success,” says bariatric surgeon Dr. Daniel J. Rosen.
“You may have tricked yourself into eating more and more,” adds Dr. Hratch Karamanoukian, a vein specialist.
Dr. Abraham Krikhely, a bariatric surgeon, describes it like this:
“Simply put, life happens. Weight gain a few years after bariatric surgery is often the result of personal changes. You regain because you’ve had kids, you’ve just left a relationship, you’ve changed the way you eat, your finances took a hit, you have a new job, or maybe because you’ve just stopped exercising. Circumstances play a big role and so does attitude. I often tell my patients, the shape of your stomach is less important than the shape of your mind.”
It’s important to take stock of your situation. Are you making the right food choices? Are you physically active? Are you eating to comfort yourself? If behavioral and lifestyle factors are the root cause of weight regain then it’s critical to address those before considering revision weight loss surgery.
Weight Gain Due to Anatomy
There are people who don’t lose adequate weight or regain weight for anatomical reasons.
Dr. Krikhely states, “You might come for revision surgery if your stomach has stretched out allowing you to eat more than you did right after your initial surgery… we expect the stomach to stretch with time.”
“If you lost weight initially and then gained weight, you likely stretched out your pouch. There are salvage procedures available which may include revision weight loss surgery,” concurs Dr. Scott. E. Kasden, a plastic surgeon.
But bariatric surgeon Dr. Mark Pleatman has an opposing viewpoint:
“It’s a common misconception that weight gain after gastric bypass is from stretching of the pouch. The fact of the matter is that we really don’t know. There are patients with big pouches and dilated stomas (the opening between the stomach and the small intestine) that do great. We can’t really correlate the anatomy with the success of the operation. If a patient has gained weight and we see one of those things, we may assume that this is the problem; but we can’t be sure. Patients undergo revisional surgery where the pouch is made smaller… and they still don’t lose weight. So many surgeons are reluctant to offer these types of revisions because we don’t want to do an operation that won’t work.”
Revision Weight Loss Surgery Options
Dr. Pleatman continues, “There are a number of endoscopic procedures to shrink the [gastric bypass] pouch or the stoma; such as ROSE, StomaphyX, and sclerotherapy. ROSE and Stomaphyx are already off the market, as they don’t work. Sclerotherapy is just injection of a medication around the stoma, and has had some limited, though temporary success. The best thing about it is that it is relatively inexpensive. The most reliable revision is conversion to duodenal switch, or doing a major revision of the small bowel anatomy to create malabsorption. The latter option is fairly easy to do, and would be successful in giving you better weight loss, though at the expense of life-long problems with vitamin deficiency, osteoporosis, and anemia.”
Dr. Kasden says weight loss surgery revisions, “…may include revision of the pouch, or perhaps even a lap band [over the gastric bypass pouch]. Also possible is to move the intestine downstream more so less food is absorbed… failures in bariatric surgery are not rare.”
The gastric band has the highest rate of revision. “That surgery was very popular until a few years ago but about a third of those patients now require additional surgery to lose weight, because there has been a loosening or slipping of the band over time. If you’re in this category, you may be a good candidate for revision to a sleeve gastrectomy or a gastric bypass,” adds Dr. Krikhely.
He goes on to say, “Research shows that two years after the sleeve operation, the volume of stomach can double… some patients begin to eat more. This group may benefit from a revision. Options include conversion to a bypass, conversion to a duodenal switch or re-sleeving.”
Revision Weight Loss Surgery Risks
It needs to be noted that the risk of complications in revision weight loss surgery is higher than in the initial weight loss surgery.
In Greece, a study was conducted on 56 patients who underwent revisional weight loss surgery at one institution between 1995 and 2008. The participants were followed for an average of 102 months. None died, but 19 patients (33.9 percent) had serious complications within 30 to 90 days, including internal leakage from the surgical site, acute kidney failure and pneumonia. Late complications (after more than 90 days) were experienced by 13 patients (23.2 percent) and included development of a hernia at the incision site, narrowing of the passageway between the stomach and intestine and low levels of albumin in the blood.
Weight Loss after Revision Surgery
“You lose between 20% and 40% of excess weight. It can be very favorable with lifestyle modification. However, it is never like in primary surgery. The recommendation is to evaluate how and what you are eating and drinking, if you are exercising or not. Revision weight loss surgery is not the only answer — if you do not change your lifestyle, this is what makes the difference,” says Dr. Pablo Garcia, a bariatric surgeon.
In the Greece study cited above, the findings were that patients who had revision weight loss surgery due to inadequate weight loss from the primary surgery experienced a significant decrease in BMI, from an average of 55.4 to an average of 35, and an average loss of 68.9 percent of excess body weight.
Bottom Line on Revision Weight Loss Surgery
Bariatric surgeons learn from their experience and the experience of other surgeons. And so today they are able to do things that were not available back in 2003 when I had weight loss surgery. “And so, some patients come to us asking for a new procedure that will make it easier for them to lose weight faster,” says Dr. Krikhely. “Many patients use this surgery to get a second start.”
Your options for revision weight loss surgery largely depend on your anatomy and the procedure you had initially, the initial success of that procedure, as well as your particular life circumstances. With this information, your bariatric surgeon can see what options might be right for you.
Living larger than ever,
My Bariatric Life