What is Revisional Surgery?
Revisional bariatric surgery, typically applies to planned reoperations for either inadequate weight loss, or for problems inherent to the original surgery which did not manifest early on. Having another operation to address something related to an original bariatric procedure is probably not high on any patient’s postoperative expectations list. These procedures are best carried out by more experienced bariatric surgeons at facilities that can provide the necessary support, like those we feature here at University Bariatrics. The high level of skill necessary to perform these operations makes experience and a proven track-record of excellence a must.
Types of Revisional Surgery Offered by University Bariatrics:
Vertical Banded Gastrectomy Revisional Surgery:
The vertical banded gastroplasty was a popular operation in the 1980’s and early 90’s. The stomach was partitioned but not fully divided into two segments. The smaller portion was further restricted by placement of a band at its end to obstruct oral intake and cause early satiety. Intestinal rerouting was not utilized. Gradually, VBG was abandoned in favor of the gastric bypass procedure, in part due to complications related to the band or the staple line. The University Bariatrics team has performed several laparoscopic revisional surgeries including full reversal or conversion to the gastric bypass.
Vertical Sleeve Gastrectomy Revisional Surgery:
Laparoscopic conversion of sleeve gastrectomy to gastric bypass is typically carried out for technical complications seen in poorly performed sleeves, incomplete resolution of comorbidities, or side effects such as reflux unresponsive to medical therapy. Typical revision is a conversion to a gastric bypass or rarely, a re-sleeve gastrectomy.
Roux-En-Y Gastric Bypass Revisional Surgery:
Complete reversal of the RYGB is rarely performed but may be necessary in cases of medical or surgical side effects refractory to conservative therapy. The University Bariatric team has successfully performed these cases laparoscopically.
Goals/Motivation for General Revisional Surgery:
Multiple procedures have been introduced by the industry to address ongoing and lingering issues after surgery. Their common goal is to provide additional restriction by adding foreign bodies, tightening, or even re-stapling/trimming of gastric pouches and surgical anastomoses. Although the stretching of surgical areas is a natural and well-described phenomenon, the extent of influence on recidivism is debated.
Revisional intervention can include placement of rings or even Lap Bands around them. Endoscopic suturing of pouches and surgical hookups can be performed as well. Whereas their short-term results have held promise, most have been ineffective in the longer run. Foreign bodies left behind as part of these procedures, furthermore, will impede safe application of surgical staplers during their ultimate conversion to gastric bypasses and duodenal switches.
The University Bariatrics team believes that by playing on patients’ hopes and fears, some programs tend to overstate potential benefits without giving much detail on side effects and alternatives. The resolution and improvement of medical comorbidities are the primary objectives of the bariatric surgery we perform, and not an idealized final weight. Focusing on the latter, furthermore, can lead to the very same issues and coping mechanisms that resulted in morbid obesity in the first place. Inadequate weight loss and significant weight regain are multifactorial issues that often do not lend themselves to just adding more surgery. It requires a more fundamental approach to the whole patient, which our multidisciplinary group is able to offer.
To get more information, We recommend that you watch our free online bariatric surgery seminar as well as the relevant modules on EMMI, a patient education program. www.my-emmi.com/SelfReg/UNIVERSITYBARIATRICS