As we continue to provide care to the patient with obesity, we are increasingly cognizant of the chronic, complex nature of obesity. Sometimes a weight loss procedure will not lead to as much weight loss as the surgeon and patient hope for, or it can be associated with long-term complications. We believe that all bariatric surgery patients are entitled to and deserve revisional surgical therapy for either partial or no response to initial therapy and/or complications. This can compare with a diabetic patient requiring two to three medications to keep their disease under control.
Different Types of Revision Bariatric Surgery
Surgical reversal (also called “takedown”) of bariatric surgery is needed when the individual develops complications from the original surgery such as stricture or obstruction.
Reoperation of a previous bariatric surgical procedure or conversion to another medically necessary procedure due to inadequate weight loss (for example, removal of LAP-BAND® and conversion to sleeve gastrectomy).
The options for revision LAP-BAND® surgery are converting to a:
- Duodenal switch
- Gastric bypass
- Sleeve gastrectomy
Options for Revision of Gastric Sleeve
- Endoscopic revision of the sleeve
- Converting a gastric sleeve to a gastric bypass
- Converting a gastric sleeve to a duodenal switch
- Laparoscopic revision of the gastric sleeve, such as by folding (plication)
Options for Revision of Gastric Bypass
- Endoscopic revision of the pouch and the connection of the upper intestine to the pouch (gastro-enteral or gastro-jejuno anastomosis). This is done to reduce pouch size.
- Laparoscopic distalization (moving, lengthening or shifting position) of the bypass limb (section of upper intestine, jejunum), which may affect the rate of food absorption.
- Laparoscopic banding of the pouch, adds a LAP-BAND® or similar device around the gastric pouch to restrict its size. This is more easily done than restructuring the pouch itself.
- Laparoscopic revision of the gastric pouch, such as by folding (plication), or revision of the ‘candy cane’ (twisting) portion of the jejunal limb.