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Revisional Bariatric Surgery
What Is Revision Surgery?
Although most patients experience successful weight loss surgery, some instances require revisional bariatric surgery. A revisional operation is used to correct one of the many types of weight loss surgery procedures when it has failed due to inadequate weight loss or weight regain, unresolved comorbidities, or unresolved complications.
While bariatric surgery can be extremely beneficial in the beginning, its effects can plateau over time and cause the weight to return. It’s important to keep a healthy lifestyle long after the initial effects of the bariatric surgery have taken place. However, if complications occur, revisional bariatric surgery can be considered as a way to treat obesity.
Obesity is a chronic disease and not easily treated. As with any medical condition, if the first treatment is not effective, an additional treatment such as a bariatric revision procedure may be needed.
Advanced Laparoscopic Associates (ALA) of New Jersey are one of the only practices in the area with bariatric surgeons experienced enough to perform these corrective procedures. Whatever your needs may be, a revisional solution is likely available to address your concerns.
Robotics Revision Surgery
ALA uses the most advanced technology available to optimize successful results, such as robotic-assisted bariatric revision surgery. Although robotic-assisted surgeries were performed as early as 1999, their use is emerging as an additional method in bariatric revision surgeries, comparable to laparoscopic procedures.
Robotic-assisted surgery is still conducted by your surgeon. However, with the demand for more technically advanced revisions, robotic-assistance is able to enhance the precision that the surgeon can provide. Utilizing magnified, high-definition, and three-dimensional video technology, the surgeon works at a console with tiny instruments that transmit every hand movement into smooth maneuvers by robotic arms, enhancing a surgeon’s dexterity.
Studies have been conducted to compare robotic-assisted revisions with laparoscopic revisions. Evidence suggests that in complicated revisional procedures, robotic-assistance may provide patients with a shorter postoperative hospital stay. A lower rate of complications such as leaks, strictures, and hemorrhaging have also been seen when using robotic procedures.
Types of Revision Surgery
According to the American Society for Metabolic and Bariatric Surgery (ASMBS), revision surgeries can be divided into three main types.
- Corrective: This type of revision surgery is meant to fix problems with the original surgery.
- Conversion: Conversion surgeries convert one type of bariatric surgery into another. When the treatment considered for the first bariatric surgery isn’t right for the patient and the desired results are ineffective, conversions can be beneficial as another treatment option.
- Reversal: Reversal revision surgeries restore the stomach anatomy to its original form (some types of bariatric surgery are irreversible).
How Bariatric Procedures Are Revised
Different bariatric procedures often require different types of revision surgery. Further, each revision is decided on a case-by-case basis. Obtaining accurate information about the initial surgery and existing anatomy is the key for a successful revision and keeping complication rates low.
Our bariatric surgeons will need to determine if the cause of the weight loss failure is due to a problem with the initial procedure or the patient’s inability to follow the necessary dietary and lifestyle changes. At ALA, our surgeons will review your old records and perform all the required tests such as an upper gastrointestinal study, endoscopy or others to choose the right revision procedure for you.
- Bowel obstruction
- Fistula (a hole in the stomach or intestines)
- Gastroesophageal reflux disease (GERD)
- Inadequate weight loss
- Re-emergence of obesity-related conditions such as diabetes, heart disease, or sleep apnea
- Weight gain
For specific types of weight loss procedures, here is how they are usually revised:
- Gastric band: In a gastric band procedure, a band is placed around the upper part of the stomach, limiting the amount of food you can eat and creating a feeling of fullness. Gastric bands are easily reversible, and they can also be converted to gastric bypass, gastric sleeve, or SIPS.
- Gastric bypass: With a gastric bypass procedure, part of the stomach is sectioned off, bypassing part of the intestine to limit the amount of food that can be eaten and the calories that can be taken from food. Revision of a gastric bypass is usually corrective, as opposed to a conversion or reversal.
- Gastric sleeve: This common procedure involves removing a large portion of the stomach leaving the remaining stomach shaped in a tube or sleeve, limiting the amount of food that can be consumed. During a revision, the stomach can be re-sleeved (re-shaped), converted to a gastric bypass due to weight gain or severe GERD, or converted to duodenal switch.
- SIPS: Stomach Intestinal Pylorus Sparing (SIPS) removes part of the stomach and changes the process of digestion by changing the channel through which nutrients pass in the lower intestine. Revision to SIPS is usually corrective.
Results of Revision Surgery
Revisional procedures are usually successful in resolving associated problems and prompting further weight loss. These procedures are generally done laparoscopically. While very safe, revision operations can be more complex and are usually slightly higher risk operations than first-time operations.
However, even with the slightly elevated risk of revision surgery, choosing not to perform them can be more dangerous. The health conditions that prompted considering the revision may get worse.
Although bariatric surgery is a safe and effective form of treatment for obesity, it is not a cure. Some weight regain after bariatric surgery is normal, but if the weight gain is extreme, a revision to a different type of procedure or a correction of the original procedure may bring the weight back down.
Recovery time will be similar to a first-time operation. According to a 2014 study in the Journal of Gastrointestinal Surgery, hospital stays were slightly longer for a revision surgery than an original surgery. Weight loss results and total recovery time were similar.
Whether you’ve developed a new health condition or just aren’t seeing the results you’ve expected from your bariatric surgery, we can help. One of our expert surgeons will determine the reason you need a revision surgery and the type you need. We will work with you to create a treatment plan that addresses your concerns and fits your lifestyle. If you need a revision surgery, don’t wait. Request an appointment with Advanced Laparoscopic Associates today.
For additional information, all prospective patients are invited to attend a free educational seminar.
Seminars are a great source of information about the procedure you are considering, and they allow you to meet the surgeons as well as ask any questions you may have. You may also have the opportunity to meet some post-operative patients.