Understanding Bariatric Revision - A Comprehensive Guide

Patients who have had a previous form of weight loss surgery may need to undergo bariatric revision. This can be because of complications or a lack of significant weight loss results.

Revision surgery can be performed endoscopically, so your doctor can change your stomach pouch without making any incisions. During this procedure, the doctor will use an endoscope to return your stomach’s capacity to its original size.

What is Bariatric Revision?

What is bariatric revision? Bariatric surgery is widely considered to be the most effective method for treating morbid obesity and its related co-morbidities, such as type 2 diabetes.1,2 However, it is not without its challenges, and patients may need to undergo bariatric revision surgery to correct complications or achieve sustained weight loss.

It is not uncommon for many patients to regain weight after bariatric surgery. Whether it is due to poor compliance, unintended symptoms such as acid reflux or dumping syndrome (where food moves from the stomach into the small intestine too quickly after eating), lack of sustained weight loss, or problems with their original surgical procedure such as a sagging gastric bypass pouch or staples that fail, it can lead to significant health issues such as heartburn and acid reflux.

When this happens, patients are often disappointed that their weight loss surgery has not produced the desired results and seek out doctors for help. The answer for many is bariatric revision surgery.

This can involve converting a sleeve gastrectomy to a gastric bypass, repairing staple failure on a stomach stapling or gastroplasty operation, or in some cases, even converting to the more complex duodenal switch. Bariatric revision surgery helps resolve a patient’s complications and reestablish their original surgical method as an effective weight loss tool for the long term. This helps patients experience improved dietary habits and often leads to more sustainable weight loss and improvement in associated health issues such as gastrointestinal problems and type 2 diabetes.

What are the Risks of Bariatric Revision?

Patients who struggle to lose weight after their initial bariatric surgery or have experienced complications from the procedure may be candidates for bariatric revision. Revision surgery can help patients regain control of their health, address issues such as acid reflux and heartburn, and start seeing significant weight loss.

If you have had a gastric bypass or sleeve gastrectomy, years of medical evidence show that they are effective at helping you achieve long-term weight loss. However, 20-35% of patients find their results could be better and begin regaining weight after surgery. This can be due to an enlarged stomach pouch that allows more food to be consumed or to complications from the original surgery, such as malnutrition or diarrhea.

A surgical team will closely examine your health and determine if you are a good candidate for bariatric revision surgery. Most surgeons recommend a revision if your original surgery has been unsuccessful in helping you lose weight or if you have experienced complications after the operation.

Your surgeon will also take X-rays of your stomach to check the size of your gastric pouch and determine if it has become too large over time. Most revision surgeries are done laparoscopically, requiring only small incisions to insert the camera and tools. At True You, our doctors have performed dozens of these operations and can offer expert guidance in determining if you are a good candidate for the surgery.

What are the Benefits of Bariatric Revision?

Often, patients who undergo bariatric revision surgery are experiencing complications from their previous procedure or are not achieving significant weight loss results. This can be due to complications from the surgery or simply because they have not committed to healthy eating and exercise habits. Regardless, patients who have had their original bariatric surgery and do not reach their weight loss goals should consider discussing surgical options with a doctor.

The primary benefit of revision bariatric surgery is that it can help patients regain control over their diet and lifestyle to lose weight and achieve their long-term health goals. It can also relieve chronic conditions related to obesity, such as acid reflux and heartburn. In many cases, patients who undergo a successful revision procedure can even stop taking previously prescribed medications.

In addition to these benefits, revision surgery can be more effective than the initial bariatric procedure in some cases. During most types of bariatric surgery, the stomach is made smaller (into a pouch-like sleeve) to restrict food intake and promote weight loss. Over time, the capacity of this pouch can stretch out or enlarge due to overeating, causing the patient to feel less full and satisfied with their meals. Revision surgery can reverse this effect by resizing the stomach pouch or altering the connection between it and the small intestine to restore its restrictive abilities. 

How Can I Know if I Need Bariatric Revision?

If a patient is having trouble losing weight or experiencing complications from their original bariatric surgery that make it difficult to tolerate, they may benefit from a revision procedure. The best surgical options for a bariatric revision will depend on what procedure was originally performed, the patient’s weight loss goals, and other factors like their base metabolic rate and physical condition.

Most bariatric revision procedures are minimally invasive, even if they involve repairing areas of the stomach that were altered during the initial surgery. Many of these revisions are performed endoscopically, which allows the surgeon to perform the procedure without making any incisions. Some of the most common revisions we perform are for patients who have a Lap Band, which is an adjustable silicone band placed around the top portion of the stomach to restrict food intake, but who experienced loosening or “slipping” of the band over time, resulting in difficulty losing weight or experiencing uncomfortable symptoms like reflux and heartburn.

Another frequently performed bariatric revision is for patients with a gastric bypass and complications like an abnormal connection between the stomach and intestine, causing food to pass too quickly through the digestive system, resulting in malabsorption and poor weight loss. This can be fixed by performing a bariatric revision to convert the stomach pouch to a gastric sleeve, which retains the bypass’s restriction and malabsorption while preventing food from passing too quickly into the small intestine.