Bariatric surgery can provide significant, long-term benefits but sometimes problems develop following the original procedure. Food intolerance, ongoing reflux and weight regain are among the most common reasons people seek further advice.
In this video, bariatric surgeon Richard Babor discusses revisional bariatric surgery and some of the procedures he performs most often. Revisional surgery needs to be considered carefully, as operating in an area that has already undergone surgery can be more complex. However, with the right assessment and realistic expectations, there are often effective options available.
Removal of a gastric band
Gastric band surgery was once a common form of weight loss surgery and is not offered or recommended by Auckland Weight Loss Surgery. However, some people now have bands that are no longer working effectively or are causing ongoing problems such as difficulty tolerating certain foods. For many people, the band simply becomes an ongoing source of frustration.
Removing a gastric band is generally a relatively straightforward procedure. It can often be completed as day surgery, although this will depend on the individual and whether there are any complications associated with the band.
After removal, some people may choose not to have another weight loss procedure. For others, further surgery may be considered, particularly if weight regain is a concern. This requires an individual assessment to determine which approach is most appropriate.
Revisional surgery for reflux
Reflux is not uncommon following gastric sleeve surgery. Symptoms can include heartburn, regurgitation, chest discomfort or an unpleasant acidic taste.
Medication and lifestyle changes can often help manage reflux. However, when symptoms are persistent, severe or no longer adequately controlled with medication, revisional surgery may be considered.
One option is to convert the gastric sleeve to a gastric bypass. A Roux-en-Y gastric bypass is often a reliable way to improve reflux because it changes how food and digestive fluids move through the upper digestive system.
Before recommending surgery, the surgeon will need to understand what is causing the symptoms. This may involve an endoscopy, sometimes called a telescope test, to examine the oesophagus and stomach. A contrast or dye study may also be used to assess the shape of the sleeve and identify issues such as stretching, narrowing or a hiatus hernia.
These investigations help determine whether revisional surgery is appropriate and which procedure is most likely to provide a good result.
Revisional surgery for weight regain
Some weight regain can occur after bariatric surgery. This does not necessarily mean the original procedure has failed, and it is important to look at the full picture before considering another operation.
The assessment may consider eating patterns, appetite changes, medications, hormonal or metabolic factors, and whether the anatomy created by the original surgery has changed over time.
Following a sleeve gastrectomy, revisional options may include conversion to a:
- One anastomosis gastric bypass, sometimes called a mini gastric bypass
- Roux-en-Y gastric bypass
These procedures can support further weight loss, although the amount of weight lost after revisional surgery is generally less than would usually be expected following a first bariatric procedure. Setting realistic expectations is therefore an important part of the decision-making process.
Revisional surgery may still be worthwhile for many people, particularly when weight regain is affecting their health or quality of life. The potential benefits need to be considered alongside the increased complexity and risks associated with operating on previously treated tissue.
Careful assessment is essential
There is no single revisional procedure that is right for everyone. The most suitable approach depends on the original surgery, the symptoms or concerns that have developed, and the person’s health and goals.
Revisional bariatric procedures require significant surgical experience and careful planning. Pre-operative investigations help the surgeon understand the existing anatomy, identify any structural problems and recommend an appropriate treatment.
Food intolerance, reflux and weight regain can be difficult and discouraging, but they do not always need to be accepted as permanent. With specialist assessment, there may be options to relieve symptoms and improve long-term outcomes.
Learn more about revisional bariatric surgery at Auckland Weight Loss Surgery or contact the team to arrange an assessment.
