Revisional Bariatric Surgery

Despite the best efforts of surgeon and patient, there are times when weight loss surgery does not offer the weight loss and disease resolution that was expected. Generally speaking, less than optimal outcomes may be due to a patient’s lifestyle after bariatric surgery or due to the potential complications of the surgery itself.

Revisional surgery should not be considered without a full workup of possible lifestyle issues hindering weight loss as it poses greater risks, over and above the primary bariatric procedure. Therefore, a surgeon will be very thorough when evaluating the true reason for the primary procedure’s failure before embarking on revisional surgery.

Watch a Band to Sleeve Conversion (Actual Surgery, Graphic Content)

Courtesy of Dr. Shawn Tsuda

Surgical Reasons for Failure:

Every procedure has considerations and potential complications that will need to be explained by the surgeon beforehand. If one of these complications does indeed arise, it may prevent the procedure from working as expected. In the case of gastric bypass or gastric sleeve, the stomach pouch of the original procedure may have been made too large or it may have stretched over time, allowing for the patient to eat more and subsequently regain weight. Gastric bands may cause or worsen severe acid reflux and need to be revised to a gastric bypass or duodenal switch. In the case of gastric banding, the band may have been placed improperly, or it may have eroded into the stomach, or slipped from its original position.

Patient Reasons for Failure

When a patient first complains about a lack of weight loss the surgeon will evaluate their dietary and exercise habits.

It is important to remember that the patient has a responsibility to follow strict nutritional, dietary, and exercise guidelines in order to ensure their success and optimal weight loss. Sometimes, patients were not quite ready to change their lifestyle and they hinder their weight loss progress as a result. For example, drinking high calorie, high sugar beverages, introducing empty calories into the patient’s system, creating a negative impact on weight loss goals.

It is important to stress that weight loss surgery is just a tool and patients must be committed to following their bariatric program’s recommendations by following the prescribed diet and exercise plan.

Remedies

Each procedure can be revised in some way. The following procedures are the most common revisions performed revising primary bariatric surgery procedures:

• Gastric Band to Gastric Bypass, Gastric Sleeve, or Duodenal Switch
• Gastric Sleeve to Gastric Bypass or Duodenal Switch

Depending on the reasons for the failure of the procedure, one of the above revisions may be right for the patient. Only with the advice of an experienced bariatric surgeon, can the patient decide which procedure is best.

A Note on Expectations

While there are standards of success that a surgeon uses, a patient’s expectations can also play a part in “success.” Patients should set their expectations at a reasonable level. Speak to your surgeon in order to fully understand the rate and amount of weight loss expected after each specific weight loss procedure. Having overly high expectations can make a successful procedure seem like a failure. Read more about expectations of bariatric surgery.

Updated March 13, 2023 with a band to sleeve revision/conversion video.