Bariatric surgery, weight loss, and Metabolic and Bariatric surgery refer to the same type of surgeries that help patients with severe obesity improve their health. The current procedures to help with weight loss are sleeve gastrectomy, gastric bypass, duodenal switch, and gastric banding. I will not be describing the types of procedures here, as descriptions are on this website. I will be discussing what revisions or conversions of these surgeries are and what we can expect with revisions.
First, a revision usually means re-operating while keeping the original operation intact. A revision of a LAP-BAND can mean keeping the band in place and possibly repositioning it or changing the port. Revision of a sleeve may involve making the stomach smaller or adding a bypass. Revision of a gastric bypass may involve making the pouch smaller or increasing or decreasing the bypass of the intestinal tract.
A revision is not always the answer, and this is something we would discuss in the office. In addition, we would discuss expected outcomes of surgical and medical interventions to determine what would be the best fit for the patient.
Common reasons to consider a revision are heartburn and reflux, inadequate weight loss, or recurrent weight gain over time. Other reasons include a marginal ulcer or a stricture or narrowing of part of the intestine or the connections created during the original surgery. With an intestinal bypass, we also consider intestinal blockage or obstruction as reasons to intervene surgically and help fix the problem.
Sometimes, when patients come to the office, it is quite clear that they need a surgical intervention versus a medical one. Other times, we try a more conservative approach with diet and exercise, as well as sometimes adding medications. If the conservative approach doesn’t achieve the desired outcome, we may progress to a surgical revision. It is important to understand that the decision to proceed with revisional surgery is as important as the decision to have bariatric surgery in the first place.
Some of the revisional procedures can be done on an outpatient basis, while others require a hospital stay. Most of the revisions can be done laparoscopically or with small incisions. The small incisions or laparoscopy have been shown to decrease pain after surgery. In addition, I perform certain nerve blocks that also decrease pain after surgery.
After revisional surgery, patients may be on a modified diet, which can mean going back to liquids and then purees. Just as after the initial weight loss surgery procedure, it is important to follow the dietary guidelines as the stomach and intestines heal. This is to prevent any complications or issues like vomiting, leaks, and/or obstructions.
When we consider a revision to weight loss surgery procedures, we usually need some imaging tests. These may include an esophagram or upper GI series, an upper endoscopy, an abdominal CT scan, esophageal pH testing, esophageal manometry, or a gastric emptying study. These are not all necessary but serve as examples of the testing that may be needed before proceeding with a revision of a weight loss procedure. As you can see, there is a great deal of discussion and care that goes into the decision to proceed with a revision.
