Revision surgery may be necessary for:

• Inadequate weight loss or weight regain after a ‘primary’ weight loss operation.

• Anatomic changes, where the modifications made by the surgeon during the primary procedure have not been maintained, such as, stretching of the stomach, a slipped or eroded gastric band, a leaking staple line or an opening (fistula) forming between the stomach pouch and bypassed stomach.

• Medical complications including, ulcers, scar tissue, reflux, internal hernia, malabsorption, malnutrition or bone loss.

• Persistent comorbid health conditions, whereby the primary surgery has not resolved or improved some or all comorbidities (e.g. diabetes, high blood pressure, heart disease, respiratory or vascular problems).

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COMMON TYPES OF REVISION SURGERY:

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GASTRIC BAND REVISION

The most common revision surgery we perform is conversion from a gastric band to sleeve or bypass. About a third of patients who have previously had a laparoscopic gastric band will require additional surgery. This is usually because of weight regain, severe reflux or food intolerances, but sometimes bands can slip or erode into the stomach.

The first step is to ensure that the band has not eroded with a gastroscopy and then to laparoscopically remove the band. This also gives us a chance to investigate the suitability for a subsequent operation. We do not charge any out of pocket fee for this. We need to wait at least three months after the band removal before proceeding with the second operation. This is to allow the scarring around the band to soften and reduce the risk of complications, such as a leak, with the second operation.

We will always evaluate and discuss with you which options for revision weight loss surgery are most appropriate, and suitable for you to achieve your individual needs and goals, weight loss or otherwise.

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SLEEVE GASTRECTOMY REVISION

After sleeve gastrectomy it is common for the volume of the stomach to expand over time. Some patients may regain weight and thus, may benefit from revision surgery.

In many cases a ‘re-sleeve’ is possible to trim down the stretched gastric pouch in much the same way as the first procedure. However, bear in mind that without changes in lifestyle and eating habits, the stomach can re-stretch again.

Conversion from sleeve to gastric bypass is another option for weight regain. This may involve re-fashioning the sleeve but always involves the addition of a stomach bypass. We have two options available to us in this situation: the mini-gastric bypass (OAGB) or the Roux-en-Y (RYGB). Both result in some malabsorption of food, which is great for calories, but not for nutrition, so you will need to take vitamin supplements and have yearly blood tests. In cases of severe reflux after sleeve gastrectomy the only option we use is conversion to RYGB.

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GASTRIC BYPASS REVISION

Patients who have undergone gastric bypass surgery may regain weight slowly over the years. Often this is due to lifestyle issues but we would investigate this thoroughly, as if there is an underlying anatomical problem, such as a gastro-gastric fistula or pouch dilatation, then there may be a revisional surgical solution to eliminate the issue and allow you to continue working toward achieving your weight loss goals.

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GETTING BACK ON TRACK

Weight regain may be due to lifestyle issues such as reversion to poor diet or exercise habits. We firmly believe in a team approach and staying engaged with us can keep you on track or get you back on track! All weight loss surgeries are tools to aid you with your weight loss, the real success lies in changing your mindset and your lifestyle. Dietary, behavioural, psychological and lifestyle factors are always important to look at before considering further surgical intervention for weight regain. But, it may be difficult to seek help or advice when you feel as though you have not achieved or maintained your goal weight after surgery. We are here to help and guide you in the right direction. Every patient’s circumstances are different, and we will take the time to find the right solution for you, whether it be improving your current situation, or converting to a better, safer and more effective longer-term alternative.

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