When you first got bariatric surgery, you probably had a vision of the future in mind. You probably envisioned significant weight loss, a decrease in weight-related health issues, and increased energy. In general, bariatric surgery is indeed effective: over 85% of patients lose 50% of their initial excess weight and keep it off.
But what about those rare cases when the surgery isn't completely effective? When you lose the weight initially but find yourself gaining it back? When your anatomy changes over time, and the originally procedure is no longer effective? In some cases, revision surgery might be an option for you.
Why Would A Patient Need Revision Therapy?
No surgery is completely effective, 100% of the time. However, those who find themselves gaining weight back years after an initial bariatric bypass surgery might feel confused or concerned. If you feel like your surgery or procedure is no longer as effective as it was when you first had it done, your instincts might be correct. Though weight loss surgery is often effective, with long-lasting results, there are some situations outside of your control:
- Ineffective first surgery. Depending on where and when you had your initial surgery done, there's a chance that your stomach pouch wasn't made small enough from the beginning. As a result, it's possible you've struggled to keep weight off after a little while.
- Stretched stomach. After time, the stomach pouch that's formed during gastric bypass surgery can become stretched out or enlarged. When this happens, it's possible your weight loss progress has reversed.
- Stretched stoma. Your stoma is the opening between the stomach and small intestines. If it becomes enlarged or stretched out, it can contribute to weight regain.
- Stretched Lap Band. Some people who have had lap band surgery, which uses a silicone band to create a smaller stomach pouch, may start gaining weight as the band stretches.
Though extremely rare, there are some complications of weight loss surgery that will also necessitate revision surgery:
- Gastric band erosion, which results in the band growing into the stomach.
- Fistulas that develop between the gastric pouch and the stomach remnant.
- Serious complications like perforations, food impaction, and acute gastric prolapse.
- Candy Cane Syndrome, in which the non-functioning portion of the small intestine causes nausea, vomiting, and abdominal pain.
Most of the time, revision therapy is needed to address a stretched out stomach, stoma, or lap band. If, however, you continue to feel abdominal pain after your surgery —or feel as though you're not absorbing enough nutrients — it's important to see your doctor to rule out anything serious.
What are Some Different Kinds of Revision Therapy?
Though everyone's situation will be slightly different, there are a few major forms of revision therapy that you might encounter as you discuss options with your bariatric surgery team:
Sclerotherapy for Dilated Stoma
This solution seeks to help patients who have experienced stretching of the stoma. When the stoma becomes too widened or stretched, it no longer limits food intake as adequately as before. To address this, your surgeon would inject a "sclerosant" into the stoma. The purpose of these injections is to create scar tissue in the stoma, effectively shrinking it over the course of a few sessions.
Band to Gastric Sleeve Revision
For patients who initially had a gastric band that failed, Band to Gastric Sleeve Revision can offer a lasting solution. In this minimally-invasive procedure, the surgeon converts your previous lap band to a gastric sleeve. With a gastric sleeve, your stomach's volume will be decreased substantially without any impact on your intestines. This allows you to keep absorbing nutrients like normal, and can help get you back on track with your weight loss goals.
Other types of revision surgeries available:
- Band to Gastric Bypass
- Band to Duodenal Switch
- Sleeve to Gastric Bypass
- Sleeve to Duodenal Switch
- Gastric Bypass to Duodenal Switch
Is Revision Therapy Right for You?
When you're considering revision surgery, you and your doctor need to take several factors into consideration. For example, if you're gaining weight because you're having difficulty adhering to your diet and exercise program, revision surgery might not be the correct option right away.
Instead, it's a good idea to work with your doctor on how to develop better eating and exercise habits. Before determining that you're a good candidate for revision surgery, you'll probably want to go through some important steps:
- Assess Diet. Have you been keeping track of meals? Has stress or another life event changed your eating habits considerably? Is there any way you can get back on track with healthy habits?
- Exercise. Your doctor will want to know if you have been sticking to an exercise program. In some cases, doctors may check your base metabolic rate (BMR) to see if you need any special fitness advice or guidance.
- Check anatomy. If you haven't been able to slow down weight gain by changing your lifestyle, your doctor might want to check the size of your stoma and stomach to see if stretching is the reason for your difficulties.
Ultimately, the decision to get revision surgery is something that varies from person to person — and requires an in-depth consultation with a bariatric team. If you want to find out if revision surgery is the right option for you, reach out to our team at My New Beginning, a department of City Hospital at White Rock. A consultation with our team of weight loss experts can help you consider your options, make a decision, and regain control over your health and weight.