Lauren A Poliakin MD, FACS, DABOM


2750 Sycamore Drive, Ste 210
 Simi Valley, CA 93065

HCA Healthcare Magazine


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Bariatric Revision Surgery

Bariatric surgery is usually a successful procedure that helps a patient achieve significant weight loss. In addition, there are normally minimal to no complications associated with the surgery. However, some patients may experience problems with the surgery or they may not succeed in losing the expected amount of excess weight. In these situations, a follow-up bariatric revision surgery is sometimes necessary. The revision may be recommended for individuals who have been experiencing complications, had poor weight loss results from the initial procedure or recently gained a substantial amount of weight, increasing the risk of developing obesity-related diseases.

There are several different situations when a bariatric revision surgery may be required. It commonly involves the failure of a LAP-BAND®, gastric sleeve or gastric bypass, however, most of these problems can be corrected for most patients with a revision procedure. While most bariatric procedures are considered safe, complications may occur, including ulcers, stomach obstruction, chronic vomiting, hernia, band leakage, and dilation of the esophagus. These complications can often be improved through bariatric revision surgery.

Revision of Failed LAP-BAND

The LAP-BAND Adjustable Gastric Banding System is designed to reduce the size of the stomach so it will hold less food, facilitating weight loss in morbidly obese patients. If complications occur, revision surgery may be necessary.

During a revision procedure, the LAP-BAND is removed from the stomach. If a gastric sleeve is selected as the optimal technique to meet the patient's needs, the surgeon will then suture the stomach into the shape of a tube, or sleeve. Sleeve gastrectomy enables rapid weight loss since the patient's intake of food will be lessened and hunger will be decreased. Since no equipment is implanted, fewer complications tend to occur and the patient does not require as many post-surgical visits to the doctor for adjustments to be made.

In other cases, a gastric bypass may be more appropriate for a patient requiring LAP-BAND removal and revisional bariatric surgery. In the procedure, the surgeon uses suture-like staples to create a pouch in the top of the stomach that will take the place of the patient's original stomach. The pouch is then connected directly to a section of the small intestine called the Roux limb, bypassing the part of the small intestine in which most calories are absorbed.

Revision of Failed Gastric Sleeve

A gastric sleeve, or sleeve gastrectomy, is a restrictive form of bariatric surgery that effectively shrinks the stomach to approximately 15 percent of its original size. It is often very successful, however, in some cases it may fail to produce or maintain the significant weight loss that patients are seeking. Depending on the reasons for the failure of the gastric sleeve, the surgeon will choose a suitable form of revision.

If the gastric sleeve has stretched out and is losing its effectiveness, a new sleeve may be created. This entails the use of the same procedure as the initial bariatric surgery, which involves revising the sleeve so it is the same size or even slightly smaller than it was after the original surgery. However, if there were complications that resulted in the failure of the gastric sleeve, a gastric bypass may be recommended as an alternative. The gastric sleeve may be left in place, but the bypass will offer the added advantage of rerouting the digestive process away from a portion of the small intestine. This results in a significant restriction of caloric intake.

Revision of Failed Gastric Bypass

Gastric bypass surgery helps patients lose weight by both restricting food intake and altering the digestive process. However, over time, the pouch or bypass opening may be subject to stretching. As a result, the patient's hunger level and consumption of food may increase. To address this problem, a revision procedure may be recommended. The surgery may primarily focus on reducing the size of the pouch back to its original post-surgery capacity using sutures. In other cases, the segment of the small intestine that is bypassed may be lengthened to ensure a greater amount of calorie malabsorption can take place.

Results of Bariatric Revision Surgery

Bariatric revision surgery can be more complex and involve more risks than general bariatric surgery. Weight loss following a revision procedure may not be as pronounced as the initial bariatric procedure, but weight loss may become substantial over time. As with any bariatric procedure, the most significant weight loss results are achieved by individuals who follow the diet and exercise recommendations of their bariatric surgeon and nutritionist.

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