Losing Weight With a Bariatric Surgery Revision, Part 1

October 16, 2019

Since 2011, I have been working as a bariatric surgeon. Over this time, I have found that my patients are not seeking solutions exclusive to their weight. I am equally invested in addressing their overall health. Moreover, it is not uncommon to see patients who have already undergone a bariatric procedure and need help addressing a number of issues to include inadequate weight loss, weight regain, and/or complications resulting from their original surgery. Of course, this is a particularly stressful situation for patients.

Stress Involved With a Bariatric Surgery Revision

As we know, undergoing bariatric surgery for the first time is inherently taxing on the patient. Therefore, one can imagine the extra stress involved in having to undergo bariatric surgery for a second time.  Therefore, I have made it a priority to distinguish myself as a bariatric surgeon with a unique skill set available to address revision surgeries.  It is fair to say that I specialize in these more complicated cases. In fact, approximately 40% of my practice is comprised of revision surgery.

Over the years, I have worked with patients who have undergone previous lap-band, sleeve, stomach stapling (VBG), and even gastric bypass surgeries. There are a variety of reasons why a patient’s original surgery resulted in unforeseen negative consequences.

For example, the initial surgery may have been the wrong option for the patient given his or her BMI. For instance, a sleeve gastrectomy will typically provide patients with a net loss of 65% of their excess body weight (that is, they will lose 65 lbs for every 100 lbs they are overweight). However, if patients have a BMI over 50, they may still be morbidly obese (BMI > 35) even if they lose all the weight that the sleeve can provide. In this instance, the patient would have benefited from a gastric bypass or duodenal switch as they both offer more upfront and long-term weight loss.

In addition to inadequate weight loss or weight regain, patients can experience several other complications to include the following: nausea, vomiting, food intolerance and reflux from band prolapse, anatomic complications from inadequate sleeves, and ulcers / persistent pain with gastric bypass secondary to surgical failure.

As you can see, it is of primary importance that your surgeon provide the proper education relative to the appropriate surgery to pursue in an effort to avoid these problems down the road.

The ASMBS Findings for Revision Surgery

The American Society for Metabolic and Bariatric Surgery (ASMBS) has specifically looked at the outcomes for revision surgery and their success rates. Research in this area emphasizes that “with any surgery, there will be a subset of patients who are non-responders or have recurrent/persistent disease or complications of therapy.”

The ASMBS further reported that “the paradigm of revision surgery is well-established for other fields.” For instance, there is a well-established revision rate for patients undergoing a joint replacement. “When initial therapy fails, revision, replacement, or conversion is offered. This is also seen in heart valve surgery, coronary artery bypass grafting, abdominal wall hernia repair, and oncologic surgery.  In all of these instances, the need for conversion/revision is clear and covered by insurance plans. Unfortunately, there does seem to be a bias in the field of bariatric surgery. Patients may face not only scrutiny from family and friends but may also face the real issue of not having insurance coverage for the procedure.”

As a certified bariatric surgeon with the ASMBS, I report all surgeries and outcomes to the national database. Based on this data, I have found that complication rates are the same, regardless of the surgery (be it a first-time bariatric surgery or revision).

Do Your Homework, Ask Your Surgeon!

Most importantly, I recommend that all patients seeking a revision to do their homework! Ask your surgeon the following questions:

1. What surgeries do you typically perform? Do you offer more than one surgery?
2. Do you perform revision surgery? How many revision surgeries have you performed?
3. What types of revisions do you offer?
4. What does your preoperative workup and postoperative care program entail?
5. How well do your patients do?  What are the short and long-term complications that you see in your patients?

In my experience, I have found that my patients do well with revision surgery, have low complication rates, and enjoy the benefits of more weight loss and resolution of their health problems. My basic rule of thumb is to choose a procedure that is the next level or two above the original.

So, what are the long-term success rates for the various bariatric surgeries and can/should they be revised? In my next article of this two-part series, I’ll discuss the bariatric surgery procedures and details about the revisions.

ABOUT THE AUTHOR Charlotte Hodges, MD is a bariatric and general surgeon practicing in Irving, TX bringing her experience and expertise at the New You Bariatric Center. She is known by her patients for her surgical expertise, and as a caring, knowledgeable surgeon with a great bedside manner. She is board-certified by the ASMBS and specializes in advanced laparoscopic procedures. Dr. Hodges has performed more than 3,000 weight loss and general surgeries. Read more articles by Dr. Hodges!

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