Revision Bariatric Surgery

There are many people who have undergone surgery in the past to lose weight, put their diabetes and high blood pressure into remission, or simply to live a healthier lifestyle. Unfortunately, some patients are not able to reach their goals for a variety of reasons.

• Have you had a band that is constantly causing pain, vomiting or lack of weight loss?
• Has your bypass or sleeve failed to give you the results that you want?
• Do you feel that your original surgery never gave you the feelings of restrictions you expected?

If you answered yes to any of these questions or have any other concerns since having your original surgery, then revision bariatric surgery may be the right choice for you. The highly skilled surgeons at New You Bariatric Center can help you the answer these questions and evaluate your needs at your initial consultation. We offer a wide range of medical and surgical options for patients who have previously undergone bariatric surgery. Our surgeons have performed hundreds of revisions on past weight loss procedures, from previous band and bypass surgeries to now more recently sleeve surgeries.

Ideally, all revision surgeries are performed as a laparoscopic, one-step procedure, regardless if the previous surgery was performed open or now. We will take time to discuss with our patients the circumstances when surgery needs to be staged as a two-step procedure. Our surgeons have not had an increase in complications by performing our revisions in a one-step procedure. The patients at New You Bariatric Center can feel assured that they will receive best option for revision surgery with the best possible outcomes.

The following are the revision surgeries that we routinely perform. If you have had a previous bariatric surgery, and are unclear of what the exact procedure was or if you do not see your original procedure on the list, the surgeons at New You Bariatric Center are more than happy to discuss your medical and surgical options with you.

Revision to Gastric Band

Revision of prior band placement is one of the most common revision surgeries that we perform at New You Bariatric Center. More than 50% of patients with a band need to have some type of revision surgery within 5 years of their original operation. The restrictive nature of the band can cause reflux/GERD, difficulty swallowing or tolerating foods like bread and meat, pain, or the need to frequently vomit. There is hope for our band patients and these symptoms can be resolved!

We typically recommend that patients undergo a revision surgery that can provide more than just restriction – which is what both band and sleeve procedures provide to achieve weight loss. Studies show that the best option for patients is to have a revision band to gastric bypass. However, the surgeons at New You Bariatric Center, will discuss all your surgical options based on only current medical recommendations but also on your comfort level. We want to develop a surgical plan together with our patient’s input to get the best possible outcomes.

Laparoscopic Revision of Band to Laparoscopic Sleeve Gastrectomy

In a revision band to sleeve gastrectomy, we first remove the band and all the scar tissue surrounding the band. Once the band, port and scar tissue are all removed, we then proceed with the sleeve gastrectomy. If a patient also has a hiatal hernia, we will repair this at the time of surgery as well. Typically, patients are able to lose 65% of their excess body weight, which is 65 lbs weight loss for evey 100 lbs that they are overweight. Patients also have about 1 to 3 weeks recovery time. The complication rates are low and the same compared with a straightforward sleeve gastrectomy.

Laparoscopic Revision of Band to Laparoscopic Roux-en-Y Gastric Bypass

Studies show that the gold standard for a revision band surgery is a revision of a band to a laparoscopic gastric bypass. Like other band revisions, a band to gastric bypass is performed in a single stage, only one operation. Like a band to sleeve revision, we first remove the band, port and scar tissue, then we proceed with our gastric bypass. The risks for complications are the same as a gastric bypass performed in a patient who has never had surgery before and the recovery time, 1 to 3 weeks, is the same as well. A typical patient can lose 75% of their excess body weight, which is 75 lbs weight loss for every 100 lbs that they are overweight.

Laparoscopic Revision of Band to Laparoscopic Duodenal Switch

At New You Bariatric Center, we generally recommend a revision of band to laparoscopic duodenal switch when a band patient presents to their initial consultation with a BMI over 50. Generally, we perform this laparoscopic procedure as a single stage operation. We first remove the band, port, and any scar tissue. Then, we proceed with the duodenal switch. There is no increased risk for surgical complications for patients undergoing this surgery compared to the other bariatric surgeries. Additionally, the recovery time is the same, 1 to 3 weeks. Generally, a patient undergoing a revision band to duodenal switch can lose the most weight, compared to the other two band revisions, about 85% of their excess body weight, which is 85 lbs weight loss for every 100 lbs that they are overweight.

Revision to Gastric Sleeve

Revision of Sleeve Gastrectomy to Laparoscopic Roux-en-Y Gastric Bypass

Much like the bands that were placed over the last ten years, more and more patients are opting for a sleeve gastrectomy as their preferred bariatric procedure. Unfortunately, not all patients are seeing the weight loss they desire when they undergo this surgery. We have found that there are several reasons that revision to a sleeve gastrectomy is needed.

Mostly commonly, patients may find they have inadequate restriction, and therefore less weight loss, if the sleeve was initially created too large.
Revision to a past sleeve can also help alleviate symptoms of reflux or GERD. Studies show there is a higher percentage of sleeve patients who have heartburn / GERD after surgery, even if they never symptoms before. If the reflux is so severe where medical management is not adequate, then the standard of care is to convert the sleeve to a gastric bypass in an effort to divert acid / bile flow away from the stomach.
There are also patients who simply desire to have more weight loss from their surgery, which a conversion to a bypass can provide. Gastric bypass patients have more weight loss overall and with better long term results when compared to a sleeve gastrectomy.
At New You Bariatric Center, our patients can lose 70-75% of their excess body weight, which is 75 lbs weight loss for every 100 lbs that they are overweight. There is no increased surgical risk undergoing a revision sleeve to gastric bypass. Furthermore, recovery time is the same as any of our weight loss procedures, 1 to 3 weeks.

Revision of Sleeve Gastrectomy to Laparoscopic Duodenal Switch

When a patient is seeking a revision to their sleeve, we take into account the medical and surgical history of the patient. Patients with a BMI greater than 50 are excellent candidates for revision sleeve to duodenal switch. In the 1950’s, a duodenal switch was performed as a staged procedure, with the sleeve gastrectomy as the first stage. Now we perform a duodenal switch laparoscopically as a one stage operation. Therefore, when a patient presents with a failed sleeve gastrectomy, we can very easily convert them to a duodenal switch. For patients who have a very large sleeve, this will be revised at the time of surgery to ensure the best possible weight loss.

Like all of our revision surgeries, we have found no increase in complication rates or recovery time when compared to the original surgery. Typically, a patient can lose 85% of their excess body weight, which is 85 lbs weight loss for every 100 lbs they are overweight, with little to no risk of weight regain.

Revision to Gastric Bypass

Revision of Gastric Bypass to Super Malabsorpative Bypass / Duodenal Switch

Patients have undergone the gastric bypass since the 1970’s. Since then, this procedure has undergone changes in how it is constructed, as well as transitioning from a procedure that was performed open to now almost uniformly performed laparoscopically. The surgeons at New You Bariatric Center have performed many revisions to both open and laparoscopic gastric bypasses. Like all of our surgeries, whether the original surgery was performed open or not, we will still proceed with a laparoscopic revision. There are two parts to the gastric bypass that is to be revised: the stomach pouch and small bowel rearrangement, which is the malabsorptive portion of the surgery. Prior to your revision, an EGD will be performed to size the stomach pouch. Ideally, we try to revise the stomach to a much small pouch in order to provide the patient with more feelings of restriction. In addition, we revise the small bowel rearrangement to be much more aggressive, is based on the same construction of a duodenal switch.

Recovery time for a revision to gastric bypass is 1 to 3 weeks. Also, the risks for complications is the same as all of the other cases we perform. When a patient undergoes a revision to his or her gastric bypass, we usually see a 65-75% excess body weight loss, which is 65-75 lbs weight loss for every 100 lbs. If a patient has a small stomach pouch which cannot be revised, weight loss is usually 50-55 lbs for every 100 lbs of excess body weight.

Revision to Vertical Banded Gastroplasty (VBG)

The vertical banded gastroplasty or “stomach stapling” is a weight loss procedure popularized in the 1990’s and is no longer performed due to poor long term outcomes. For these patients, we see similar outcomes to banding procedures which include inadequate loss and/or weight regain of some if not all their weight. Studies show that patients have the best outcomes with a revision VBG to laparoscopic gastric bypass. Recovery time and risk for complications is the same as all of the other cases we perform. When a patient undergoes a revision VBG to gastric bypass, we typically see a 70-75% excess body weight loss, which is 75 lbs weight loss for every 100 lbs of excess body weight.