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Revision Bariatric Surgery

Revision bariatric surgery involves the conversion of a primary bariatric procedure to a new procedure. While this can be due to the primary bariatric procedure failing — most commonly a gastric band — it is more often due to a patient’s noncompliance with their postoperative diet and exercise regimen. We always look for nonsurgical ways to get the patient back on track. If after a thorough evaluation of nutritional and exercise habits we determine there is no other option, a surgical revision may be the best option.

Revising a Gastric Band

Revisions have become more popular than ever due to long-term failure of the gastric band, also known as the Lap-Band. Fortunately, the band procedure does not change the anatomy of the stomach and, once removed, the stomach returns to its former shape, allowing for any secondary bariatric procedure to be performed. Typically, we see patients have unacceptable discomfort from their band, or they simply haven’t been able to lose weight. The band may also slip or erode. Converting the band to another procedure, such as a gastric sleeve or gastric bypass, can get patients back to weight loss and heading toward their goals. In fact, stapled procedures are significantly more effective in both disease resolution potential, as well as weight loss potential. As a result, patients who convert their band to a stapled procedure may have better results than they ever would have with their band.

The process for removing and replacing a band is relatively straightforward, although it comes with significantly greater risk than the primary bariatric procedure. First, Dr. Higa removes the band using minimally invasive surgical techniques. Robotic surgery may also be employed. The band is drained and unclasped. If it gets stuck, it can be cut and removed from the top of the stomach. The band is then removed from the abdomen through an incision in the belly button. After a quick anatomical check, Dr. Higa can then begin a gastric sleeve or gastric bypass procedure.

Revising Other Procedures

Gastric bands are not the only procedures that may need to be revised. In fact, any of the procedures offered today may fail for one reason or another. This is usually due to noncompliance by the patient, but there are occasions in which the procedure itself fails to deliver the appropriate weight loss. The gastric sleeve can be revised to a gastric bypass or duodenal switch. Gastric sleeves can fail if the stomach pouch has stretched due to over-eating or dietary noncompliance. The gastric sleeve may also cause new or worsened acid reflux in a small subset of patients, especially if a hiatal hernia has not been repaired during surgery. While this can often be corrected using non-surgical or endoscopic techniques, a revisional surgery may be the only option for some patients.

The Risks of Revisional Surgery

Revision surgeries require specialized technique and come with greater risk than a primary bariatric procedure. As such, patient should be aware of choosing a bariatric surgeon that has significant experience in these procedures. Anytime we perform a surgical procedure where a previous surgery has been performed, we encounter obstacles including adhesions and scar tissue from the previous procedure. This makes the surgery more complex and increases patient risk.

As to whether it makes sense to have the procedure, one must weigh the risk of not addressing a failed primary bariatric procedure with the risks of a secondary surgery. This is a very personal choice and should be discussed with trusted friends, family and of course your medical team. We encourage you to visit our office and schedule a consultation with Dr. Higa to learn more about your revisional surgery options and which may be best for you.