Information regarding revision surgery

I just posted this response to a question about significant weight regain 4 years postop and the question of revision surgery on the Centennial message board and I thought it may be helpful to post the information on the OH board too.

Whenever you experience a weight loss stall (plateau) or weight regain, ask yourself the following:
when was the last time I saw my surgeon?
when was the last time I saw the dietitian?
am I still following ALL the program guidelines I was given after surgery?
    this includes: eating lean, nutrient dense sources of protein most of every meal, the protein
           should be baked, boiled, broiled, grilled, poached, not breaded and/or fried;
           drinking at least 64 ounces of non-carbonated, low-calorie (less than 5 calories/serving)
           fluids every day;
           NEVER, EVER drinking with your meals;
           exercising daily;
           taking your vitamin supplements as prescribed after surgery
when was the last time I attended a support group?
when was the last time I kept a food journal?

If you have not seen your surgeon or dietitian within the last year, please plan to do so; if you've not had your labs drawn in the last year, please plan to do so; if you've not been taking your vitamins properly, please resume taking them; if you've not kept a food journal, exercised or attended a support group in the last few weeks/months/ever, please begin to do so; if you're not following your postop diet as you were given after surgery, please return to doing so. Your program should be happy to send you a new program guide if you no longer have yours.

If after three months of resuming all of the activities and guidelines you were given for success after surgery, you have not started losing weight again, then yes, you could and should be evaluated for a revision. The type of revision appropriate for each individual depends on their initial procedure, how long ago they had surgery, who performed the original procedure, why the original procedure has failed - is there something wrong with the band/pouch/opening or is it because you ate around/through the procedure? This may seem kind of harsh to some, but if the original surgery was good and the band or pouch are functioning properly and you have chosen to "out eat" the procedure, a revision is not very likely to help as you will continue to learn how to "out eat" the new procedure too. This is why we focus so strongly on saying we will make your stomach right, but you have to make your head right - attending support groups can be an invaluable part of this plan, others will need to seek one on one counseling.

If you are doing all of the above and still do not resume losing, then the surgeon will very likely order some form of test (Upper GI or Endoscopy) to evaluate how your band or pouch are functioning and then determine if you are a candidate for a revision and if so, what the revision would entail. Some insurance plans do cover revisions if we are able to prove technical failure of the original procedure - for many of the plans, you have to meet critieria for surgery just like you did with your original procedure.

I hope this helps - there are many support groups (about 40) offered every month and for our Centennial patients we have group follow up every Tuesday from 11-1 (you need to plan to be there the FULL two hours); if you had surgery at another program and you want to transfer your aftercare to Centennial, we would love to have you. The cost is a one time fee of $500.00 which gives you unlimited lifelong access to our registered dietitians, exercise physiologist and our psychologist led support groups.

Thank you for reaching out to us and asking a difficult question! I hope some of the information above will be helpful for you.

I just want to add something Pam. I see people asking about revisions, and when you ask about whether they follow(ed) the rules, they tend to be vague or it turns out that they were non compliant in following the rules specific to their procedure.  A person cannot have the mindset "well this one wasn't easy, so I'm going back for an upgrade."  But that's my two cents for what its worth...  

yes your points are valid, and while there are "some" people who have valid reasons for needing a revision, there are others who never had a lifestyle change to begin with.

Thank you Melinda, I agree with you that unfortunately, regardless of all the education provided prior to surgery, there are still a few folks who choose not to take as active of a role in their recovery process after surgery and choose not to follow the guidelines given resulting in less weight loss. There are also many people out there who had surgery several years ago, before the age of the "micro-pouch" or whose procedure just technically no longer works - meaning, if they've had a band, there may be a leak in the tubing or the inner diameter of the band itself; if they had a bypass, the pouch or the opening from the pouch to the small intestine may now be to large to work properly or their body may have adapted and they now need an additional degree of malabsorption to maintain or achieve the desired level of weight loss.

Thanks again!