Revision Bariatric Surgery
Revision bariatric surgery – sometimes known as revisional surgery - refers to a weight loss treatment that follows a previous weight loss surgery that did not lead to the desired level of success.
From beginning to end, the journey for a patient undergoing bariatric care is full of changes. It will require persistence and discipline, but in the end, it is all worth it.
What Is Revisional Surgery?
Although bariatric surgery is usually quite effective, at times, it does not work as well as one would like. In such instances, a revisional bariatric surgery procedure may be considered. It is important to remember that revision operations are more technically challenging and carry a higher complication risk. Patients need to seek out very experienced bariatric surgeons that perform revisional bariatric surgery procedures routinely. Not everyone who regains weight or fails to lose as much weight as they would have liked are candidates for revisional bariatric surgery.
One must stress that morbid obesity is a multi-factorial disease, hence a multi-disciplined approach should be utilized to treat patients that have regained or failed to lose weight. Successful bariatric surgery starts with the operation. Some operations have been done much longer and have been proven to be more durable over time. Postoperative instruction and support are also very important. Snacking behavior, poor water intake, lack of exercise, and poor supplementation intake can all lead to poor outcomes. When patients are being evaluated for a revision in our program, a consultation with the surgeon is scheduled.
Why Do We Offer Revision Surgery
Often when someone chooses to have bariatric surgery and follows the after-surgery plan, they lose a significant amount of weight and they maintain this weight loss. However, treating obesity is similar to treating other diseases so the reality is that one treatment is not always enough. Sometimes a weight loss procedure will not lead to as much weight loss as the surgeon and patient hope for. In other situations, a patient will lose the weight but later regains some or all of that weight. If this has happened to you, you should not feel ashamed or consider this a personal failure. On the contrary, this is the time to contact an expert in revisional treatment.
Our Experience With Revision Surgery
At the International Metabolic Bariatric Center, we are the foremost specialists in revisional weight loss surgery. Our program helps patients with different bariatric surgery practices from all over the world. Because of our extensive experience in caring for these patients who have regained weight, we have carefully crafted a pre-operative and post-operative program that works to ensure long-term success. Our comprehensive program is the difference between learning to live with a failed treatment and finding ultimate success in a different procedure and aftercare program.
Is Revision An Option For Me?
No matter what bariatric procedure you tried the first time, or what surgeon you worked with, we are happy to talk with you and help you understand your options for revisional treatment. Sometimes a weight loss surgery fails because it wasn’t done correctly. In other cases, it was not the best treatment for the patient and sometimes we will never know why the treatment did not work. Whatever the case, it is perfectly reasonable for anyone who tried one treatment without success, to have the chance to try a different obesity treatment. Every case is different, so we’ll work with you to evaluate your medical history, reasons for weight regain, lifestyle, and treatment preference.
If you have regained weight after bariatric surgery or the weight loss balloon, please get in touch with us and hear about your options for finding the weight loss, health, and energy you’re looking for.
“The staff and surgeons at the International Metabolic Bariatric Center are great! So many times I have seen doctors that come across as all-knowing and do not listen to their patients. This is not the case with Dr. Jaime Ricardo Ramos Kelly and his staff. They are real people that care about their patients.
Dear Dr. Kelly, just want to say thank you for making this such an amazing experience, to say that I felt cared for it's an understatement, you're a blessing ... the other amazing surgeons, Cecilia, Gabby, and Jorge thank you guys so much especially for the laughter ❤ Claudia S.
More On Revisional Bariatric Surgery
Dr. Ramos Kelly is vastly experienced in Revisional Bariatric Surgery, having performed bariatric surgery for more than 15 years. In this section, we will discuss the special concerns one must think of when undergoing gastric bypass revision.
Although bariatric surgery is usually quite effective, at times, it does not work as well as one would like. In such instances, a revisional bariatric surgery procedure may be considered. When contemplating another bariatric operation, we must decide if a gastric bypass revision will work and what the risks of such a procedure will be.
There are several factors that help us make this decision:
- When the initial operation was performed.
- Where the initial operation was performed.
- At what stage the surgeon was in his / her career.
- The postoperative instructions given after the initial surgery.
- Initial weight loss history following surgery.
- Any complications that may have occurred following the initial operation.
Now, we will discuss each of these factors affecting your potential revisional bariatric surgery individually. The type of bariatric surgery initially performed is very important when considering a gastric bypass revision because some types of surgery have been known to fail or have less long-term success. Obtaining an operative report for your surgery is very helpful. However, if you cannot provide an operative report, we can usually determine the type of surgery simply by knowing when and where it was performed.
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Nuances Of Bariatric Surgery
A “learning curve” exists for most operations and bariatric surgery has one of the longest. This is especially true when we consider the Laparoscopic Gastric Bypass. It is often helpful to know at what stage your surgeon was in their career when you were treated. For example, the success of gastric bypass surgery is largely dependent upon the size of the gastric pouch. This part of the surgery is technically challenging and often requires the surgeon to have performed many operations before mastering it. As a result, a surgeon may have made very large gastric pouches early in their career. Furthermore, some surgeons continue to make large pouches despite our current understanding that pouch size and weight loss are more directly related.
Oftentimes, the postoperative instructions given to patients are incorrect or lacking. Therefore, the patient did not know the best way to use their new “tool”. Even though the patient may be out of the “golden period” for rapid weight loss, they usually benefit considerably from proper instruction and can therefore avoid revisional bariatric surgery.
Weight loss history following the initial surgery tells us if the operation was ever effective or if it “failed the patient” from the very beginning. If postoperative weight loss never occurred or was minimal, then it is likely that there was a technical problem with the operation, and gastric bypass revision may be able to correct the problem at the root.
Likewise, complications occurring after the surgery may have led to technical problems that have influenced the durability of the weight loss. Such complications may include intraabdominal infections, ulcerations, band infections, and prolonged vomiting postoperatively.
Considering bariatric surgery as a “tool” to be used for long-term weight loss, we must determine if the patient has used their “tool” ineffectively or if the patient’s “tool” does not work. If the “tool” has not been used effectively then it is unlikely that a gastric bypass revision would be beneficial. However, if the “tool” is broken or never worked, then a revision may be beneficial.
Real World Example
For example, if the pouch of a gastric bypass was made too large then the patient may lose weight for the first year but eventually lose their sense of satiety or restriction and gain weight. Usually, an upper GI x-ray series will help us determine the pouch size, and an option such as lap band after gastric bypass may prove beneficial.
If a patient had gastric banding, they may never feel “satisfied” with small meals. Commonly, gastric banding does not give patients the same feedback of satiety that the gastric bypass provides. In such cases, a gastric bypass revision may benefit the patient. However, taking down the scar around the band can be technically difficult.
If a patient had a vertical banded gastroplasty (VBG)/ stomach stapling, they may have initially lost weight only to lose their feeling of restriction and regain the weight. Several technical failures arise with this type of surgery over time. It is appropriate to consider gastric bypass revision if one of these failures has occurred.
One Last Word
Remember that gastric bypass revision operations are more technically challenging and carry a higher complication risk. Patients need to seek out very experienced bariatric surgeons that perform revisional bariatric surgery procedures. Not everyone who regains weight or fails to lose as much weight as they would have liked are candidates for revisional bariatric surgery. Because morbid obesity is a multi-factorial disease, a multi-disciplined approach should be utilized to treat patients that have regained or failed to lose weight.
Successful bariatric surgery starts with the operation. Some operations have been done much longer and have been proven to be more durable over time. Gastric bypass surgery is one such operation. Postoperative instruction and support are also very important. Snacking behavior, poor water intake, lack of exercise, and poor supplementation intake can all lead to poor outcomes.
When patients are being evaluated for a gastric bypass revision in our program, a consultation with the surgeon is scheduled. At that time all tests are reviewed as well as the operative report if provided. Our surgeon then assesses the risks and potential benefits of gastric bypass revision surgery for the patient. If surgery is indicated and the potential risks are understood, our program can provide years of experience in revisional bariatric surgery to help you achieve your goal.