Bariatric Revision Surgery: Why A Second Procedure May Be Necessary

By Author: Dr. David Provost
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Weight loss surgery has a proven track record of success as an effective treatment for clinical obesity, but no surgical procedure is without risk. After bariatric surgery, patients can suffer from a variety of complications, including blockage of the digestive tract and malnutrition. In some cases, bariatric revision surgery may be necessary to rectify these issues and help a patient achieve a healthy body weight.
The percentage of weight loss surgery patients who need revisions is relatively low - some estimates show that 10 percent of people who undergo bariatric surgery need a revision operation during the two years after their initial procedure. Although most weight loss surgeries today are performed laparoscopically, which reduces the level of risk, any of the most common bariatric procedures could produce results that require revisions.
Gastric banding surgery (often referred to as Lap-Band® surgery) involves positioning a silicone device around the top portion of a patient's stomach. The silicone band, which has an inflatable lining, divides the stomach to create a new, smaller pouch, limiting the amount ...
... of food the patient can eat before feeling full.
Gastric bypass surgery creates a much smaller capacity for food by separating a thumb-sized pouch from the rest of the stomach. The gastrointestinal tract is rebuilt to bypass the part of the intestine, which also blocks the body's ability to absorb calories from food.
Gastric sleeve surgery involves removing 70-80 percent of the stomach, leaving a smaller, sleeve shaped stomach. This new shape results in the patient feeling more satisfied with less food.
Among these procedures, further revisions may be necessary because the patient either experiences a physical complication from the surgery, or because the amount of weight loss hasn't been as high as expected.
Common complications include nausea, hernia or ulcers, says bariatric revision surgery expert Dr. David Provost, medical director of the bariatric surgery center at Texas Health Presbyterian Hospital in Denton, Texas. In rare instances, he notes, complications are caused by technical problems, such as misplacement of an adjustable gastric band, or by an issue with the surgery itself, such as leakage along the suture line.
To confirm the complication and the need for a revision, the patient must either re-visit his or her original surgeon or consult a new one. In either case, the doctor will be able to determine whether the patient's lack of weight loss or other physical side effects are connected to a faulty surgery or to lifestyle factors.
Weight loss surgery revisions commonly include these surgical methods:
Lap-Band® and REALIZE® Band patients who experience inadequate weight loss usually need their gastric band adjusted to some degree. The unit has either moved from its original position, was not sufficiently inflated, or has deflated due to a leak. Any of these issues can be fixed (usually through laparoscopic methods), or the surgeon may recommend a secondary form of weight loss surgery, such as a gastric bypass.
Gastric bypass surgery, a more complex procedure, requires a more complex revision. Often, this is accomplished with a duodenal switch, which reduces the size of the entire stomach and re-routes the small intestine, or by using the StomaphyX system, which uses sutures to tighten a stomach pouch that has stretched. In some cases, if the stomach pouch has stretched over time, the doctor will add an adjustable gastric band to recreate the smaller pouch and reduce food intake.
For patients considering weight loss surgery, the best safeguard against a revision procedure is to seek out a highly qualified bariatric surgeon with a long track record of experience. Patients should also be aware of the risks involved, and how they can help minimize the risk of complications, such as ulcers, hernias and infections. Likewise, prospective bariatric patients need to take personal accountability for following their surgeon's guidelines for food choices and nutritional supplements, to avoid complications caused by vitamin deficiencies and malnutrition.

Although newer weight loss surgery techniques have reduced the risks involved for patients, bariatric revision surgery may be necessary when complications arise. Dr. David Provost is one of the nation's leading experts in bariatric revision surgery, as well as standard weight loss surgery procedures, such as gastric bypass and adjustable gastric banding surgery.