Revision Bariatric Surgery
Each weight loss surgical procedure has a different short and long-term result, as well as unique and long-term complications. Patients who have had complications or ill effects as a result of weight loss surgery may require other procedures to correct the original operation. These types of operations are called revision weight loss surgical procedures.
The most common revision operation we perform is converting an old failed stomach stapling (vertical banded gastroplasty) or a failed lap band into a gastric bypass or sleeve surgery. Though revision surgery is more risky, good results can often be achieved. Dr. Lourié often uses robotics for complicated gastric bariatric revision surgeries.
Conditions that may require Revisional Weight Loss Surgery include:
- Inadequate weight loss.
- Weight regain after initial weight loss.
- Dumping syndrome.
- Solid intolerance.
- Marginal ulcers.
- Nutritional deficiencies, including vitamins, minerals, etc.
- Significant bowel dysfunction (constipation, diarrhea, malodors flatulence).
- Significant gastroesophageal reflux disease.
- Infection involving implanted devices (ports or bands).
- Erosion or slippage of the adjustable band.
- Partial resolution of the comorbid conditions or recurrence of the comorbid conditions after initial or partial resolution.
- Stricture (narrowing at the site of bowel anastomosis).
The goal of the revisional weight loss surgery is to:
- Correct the problem that brings a patient under our care, including the correction of any of the above outlined conditions.
- Make the revisional weight loss surgery a definitive procedure. This will be discussed further with each type of procedure that we revise.
- Accomplish the primary goal of the weight loss surgical procedure, which is maintenance of the weight in a favorable range and resolution of the patient’s comorbid conditions.
- Revisional Weight Loss Surgery should have acceptable risk as a surgical intervention.
The majority of patients seeking a revisional weight loss surgery are those who experienced an acceptable short-term outcome after the initial weight loss surgical procedure. They may have lost the weight only to gain it back, or experienced inadequate weight loss. There are also certain patients who have had ill effects from their primary operations, including ulceration and stricture in the case of a Roux-en-Y gastric bypass, and slippage or erosion in the case of an adjustable gastric banding. While there are some patients who have been able to lose the weight and keep it off, this comes at the expense of near constant nausea and frequent episodes of vomiting. It has been our experience that the failure of primary weight loss surgical procedures is quite frequently blamed on the patient, which is usually not the case. In the majority of cases, a less than ideal outcome of a weight loss surgical procedure can be traced back to a procedure itself. A similar circumstance would involve a patient trying a number of blood pressure medications to find the one that works best. Even the best possible outcome may be inadequate for the patient and his or her particular conditions.
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