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Ask the Experts
While bariatric surgery is commonplace and growing in popularity and use, there will be rare occasions when complications arise. In most cases, this is because the patient was unable to follow the prescribed post-op plan and a healthy lifestyle, this leading to either not losing weight or even gaining weight.
However, there have been times when complications from the surgery itself mean a revisional procedure is needed. This could be from leaking staples that cause pain, a slipped band causing nausea, or an enlarged gastric pouch that promotes weight gain. In some cases, scar tissue can build up, closing passages that allow food to enter the digestive tract.
All of this information will be taken into account before a revisional procedure will be performed.
What is Revision Surgery?
Our surgeons will look at the details of each patient’s history and make recommendations to help determine if revisional surgery is indeed feasible. On a case by case basis, we will investigate why a revisional surgery might be needed, whether it can be performed, or if other solutions exist.
In general terms, revisions of previous weight loss operations or conversions from one type of bariatric operation to another are possible. We have had excellent success in this area, but several things should be kept in mind when making the decision to have another procedure done:
- Revisional operations have a higher complication rate than “first time” operations – primarily because of the scar tissue requiring more dissection of the tissues. The scar tissue and the resultant dissection may result in healing problems.
- Revisional operations require a “restart” from a psychosocial standpoint – that is to say, you must change what you do, as the operations are only a tool (this is our philosophy for “first time” patients as well).
- While revisional operations can be effective, they are usually less effective than first-time operations – you tend to lose less excess weight than “first-time” operations.
Revision Surgery Pre-Op
If a patient has already had bariatric surgery, they should be familiar with the pre-op protocol. However, MIC treats every procedure the same. That is, all of our patients go through the same screening process whether they are familiar with the process or not.
The reason we do this is that something didn’t happen the way it should have. So our surgeons will talk with each patient before determining if a revisional treatment is the proper course of action. This discussion will cover patient history.
This is especially important if our doctors didn’t perform the initial surgery. The more information we have, the better we can diagnose the patient’s issues and recommend solutions. In some situations, laparoscopic surgery may not be utilized if there is too much scar tissue from the first operation.
We also want to make sure you understand the necessary dietary restrictions as well as exercise requirements. We will want to know if you were able to comply with the post-op diet or stick with a physical activity schedule.
There are many factors why an initial Gastric Sleeve, Lap Band, Gastric Bypass or other bariatric surgeries didn’t perform as it should. That’s why we repeat the process once again to make sure everyone is on the same page before proceeding with the revisional procedure.
You are eligible for revision surgery with us when:
- You have a body mass index in excess of 35 (this limit may be reduced for those with type 2 diabetes and those with Asian/African ethnicity – due to increased Diabetes risk), you have attempted to work with your primary weight loss procedure and you are gaining weight, or;
- You have a body mass index above 30 and you are experiencing a complication with your primary procedure that necessitates surgical revision for safety reasons.
Before considering surgery for anyone we would need to establish that you have made every effort to succeed with your primary procedure and that the potential to get this procedure working without the need for more surgery has been exhausted. This is most common for gastric band patients. We occasionally find that incorrect adjustment of the gastric band, or poor aftercare, was the reason for failure. The band or access port may also be leaking given the impression of failure, when in fact the problem is mechanical (and not with the patient). In cases like this we would always attempt to get the band working as it should before undertaking more surgery.
When discussing the prospects of revision surgery with you, we are motivated by 3 things:
- Your safety and wellbeing – that your procedure can and will be undertaken safely;
- Your weight loss success – that you can expect to lose weight with the revision procedure, and;
- That the procedure will deliver the health benefits sought. This is particularly important for people already living with weight-related health problems.
If you are eligible, based on the criteria above, it’s time to discuss your circumstances in more detail.
After a “first time” operation, patients can expect to lose up to 70 percent of the excess (not overall) weight after the first six months. After that, weight loss will continue at a slower rate. To lose all of the excess weight you need to can take a year or two or more. A lot of it depends on the patient adhering to the plan set forth by our doctors.
However, weight loss may not be as fast after a revisional surgery. It’s not impossible of course, but complications from the initial procedure may slow down the weight loss process. Much of this will be discussed with the patient before the revision takes place.
If laparoscopic surgery isn’t possible because of scar tissue, open surgery will be necessary. This will delay the recovery time a day or two and may even extend a hospital stay by a night. But patients should be able to return to day-to-day activities almost immediately. Depending on what kind of work you do, you may even be able to return to work the same week.
A lot of that depends on how you’re feeling in the days following the revisional surgery. The new diet will start right away, consisting mainly of liquids and supplements for the first two weeks. From there, soft proteins can be introduced over the following two weeks and after a month or two, a regular diet outlined by your doctor or consultant can begin.
During the initial weeks, it’s important to stay hydrated, but be careful to not drink water to quicky. Your body is adjusting to the revisional surgery and will need to re-adapt to the changes. It won’t take long for hormonal changes in your body to start getting used to smaller portions and to feel full faster.
Exercise is another aspect of the surgery that needs attention. MIC believes that a lifestyle change is required to lose weight, and revisional surgery is just one part. You won’t be jogging three miles at the start, but the idea is to move forward and improve your cardiovascular system, flexibility and strength.
This is a life-long journey. While the path is narrow at the start, it will give you a solid foundation in the years to come.
If there were complications during your original bariatric surgery, or the results weren’t as you hoped, consider reaching out to us. Our consultants will talk with you about the surgery, potential reasons why it didn’t work, and suggest a course of action.