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The Second Time Around

By Robert J. Kelly, Jr, MD

Weight loss surgery is a very powerful tool used in the treatment of morbid obesity. This surgery drastically enhances an individual’s ability to lose weight and maintain that weight loss over their lifetime. However, no surgery acts as a complete cure for this condition and failure may occur for some patients, in multiple forms including unresolved weight loss, weight regain, unresolved co-morbidities and/or surgical complications. Of those listed, inadequate weight loss and/or weight regain are the most common reasons patients seek revisional bariatric surgery.


When evaluating a patient for revisional bariatric surgery, the surgeon must first establish the reason behind the patient’s failure to achieve adequate weight loss and comorbidity resolution. Misinformation or a lack of proper preoperative education regarding a particular surgery may produce inadequate results and create patient frustration with their new lifestyle. Ensuring proper education prior to bariatric surgery and providing adequate long term care as well as support through a bariatric program may be all a patient needs to achieve successful weight loss.  This also may be helpful in resolving their underlying comorbidities. On occasion, the bariatric surgery itself may be the source of the patient’s inability to lose or maintain weight loss. Failures associated with bariatric surgery stem from unintended anatomic changes that occur after bariatric surgery. These anatomic changes are specific to the type of bariatric surgery a patient initially undergoes. Examples of these changes with gastric bypass surgery include enlargement of the gastric pouch, widening of the gastric outlet, development of a gastro-gastric fistula, development of a marginal ulcer or stricturing of the gastric anastomosis. Distortions associated with the sleeve gastrectomy include stricturing and pouch enlargement. Anatomic failures associated with gastric banding include device malfunction, band infection, band slippage, or band erosion. Commonly performed revisional bariatric operations include gastric band to sleeve or bypass, sleeve to bypass, band over bypass, and bypass to duodenal switch.


Do you think you’re in need of revisional bariatric surgery? This answer can only come from a consultation with your bariatric surgeon after a thorough workup and understanding of your personal situation and medical problems. When considering bariatric surgery, the patient must consider the experience of the surgeon performing the operation. Revisional bariatric surgery is more difficult to perform than the initial surgery and is associated with a higher complication rate due to its higher complexity. The risks associated with revisional surgery may be mitigated by appropriate patient and operative selection from an experienced bariatric surgeon. For further information on revisional bariatric surgery please see a bariatric program in your location.