Despite the best efforts of both surgeon and patient, there are times when weight loss surgery doesn’t produce the weight loss and disease resolution that was expected. The reasons for less-than-optimal outcomes vary. It could be due to a patient’s lifestyle after bariatric surgery, a return to old eating habits, psychological barriers that haven’t been addressed, underlying metabolic factors, anatomical complications, or something to do with the surgery itself.
Revisional surgery is not something you or your surgeon should take lightly and is not considered without a full workup. The goal before undertaking revisional surgery is to identify what is hindering weight loss and try to address it in the least invasive way possible first. Revisional surgery poses greater risks, over and above the primary bariatric procedure: it’s complex, poses additional physical trauma to the body (as with any surgery), and excessive scar tissue can require an open rather than laparoscopic procedure, increasing surgical risk.
A surgeon will be very thorough when evaluating the true reason for the primary procedure’s failure before embarking on revisional surgery. And it is just as much your responsibility to work together to realign your goals and pick the best long-term option.
Surgical Reasons for Failure
Every procedure has considerations and potential complications that a good surgeon will explain beforehand. If one of these complications does indeed arise, it may prevent the procedure from working as expected. And because you discussed the ins and outs with your surgeon, you’ll be aware of the risks and better prepared to get through any hiccups.
In the case of gastric bypass, the stomach pouch or the connection to the small intestine (stoma) may have stretched over time. With a gastric sleeve, the stomach pouch may have been made too large during the original surgery. Either way, the result can reduce the sensation of fullness, allowing the patient to eat more and subsequently regain weight.
A gastric band, as well as a gastric sleeve, can cause or worsen severe acid reflux. Sometimes, with a gastric sleeve, it can be a wait-and-watch scenario, where you and your physician work on non-invasive ways of controlling the reflux. With gastric bands, you could move into a revision conversation sooner. If, after losing some of the weight and trying other therapies, there is no reduction in acid reflux symptoms, the original procedure may need to be revised to a gastric bypass.
In the case of gastric banding, the band may have been placed improperly, eroded into the stomach, or slipped from its original position. Many surgeons no longer perform gastric banding procedures because so many of them require revision, opting for a gastric sleeve or gastric bypass from the start.
Patient Reasons for Failure
When a patient first complains about a lack of weight loss, one of the first things a surgeon will evaluate is dietary and exercise habits.
Bariatric surgery is not an “easy fix,” and patients have a responsibility to follow strict nutritional, dietary, and exercise guidelines in order to achieve optimal weight loss. Sometimes, patients are not quite ready to change their lifestyle, or they fall back on old habits, hindering progress in weight loss. For example, if your weak spot was sodas (even diet ones!), continuing to drink high-calorie, high-sugar beverages introduces empty calories into the patient’s system, creating a negative impact on weight loss goals. Bariatric surgery has been known to help put diabetes into remission, so the high sugar can also retract that benefit.
Even if you’re following a clean diet, you have to engage in increased physical activity, not only to lose weight, but also to maintain muscle mass.
It can’t be stressed enough that weight loss surgery is just a tool, and patients must be committed to their bariatric program’s recommendations by following the prescribed diet and exercise plan. And something to keep in mind for those utilizing insurance benefits: an insurance company may not cover the revision without proof that the original post-surgery protocols were met.
Remedies
Each procedure can be revised in some way, and common combos include:
- Gastric Band to Gastric Bypass, Gastric Sleeve, or Duodenal Switch
- Gastric Sleeve to Gastric Bypass or Duodenal Switch
- Endoscopic Gastric Bypass Revision
The revision that’s right for the patient will depend on the reasons for the original procedure’s failure. Only with the advice of an experienced bariatric surgeon can a patient decide which procedure is best.
A Note on Expectations
Every good surgeon employs standards of success, but a patient’s own expectations also play a part in the perception of “success.” Patients would be well-advised to 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. Ask for and read about other patients’ experiences, knowing yours will not be exactly the same, just to get another perspective. Having overly high expectations can make a successful procedure seem like a failure.
The surgeons at MIIS Weight Loss Institute are very experienced in revision and conversion bariatric surgery, considering it one of their several specializations. If you’ve experienced a plateau or weight regain after bariatric surgery, contact our team. We will explore medical weight loss options as well as additional therapies and lifestyle modifications before jumping into revision surgery to find a solution that’s unique to you.
