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revision operations

Patients who have gastric bypass or other restriction-only weight loss operations occasionally require revision, either for inadequate weight loss or for complications. The incidence of major postoperative complications following revisional bariatric procedures is substantially higher compared to original operations. Early complication rates range from 15% to 50%. The death rate reported after revisional operations ranges is as high as 10%. Undoing any bariatric operation without conversion to another weight-reduction procedure is invariably associated with the patient's promptly regaining the lost weight.

There are many options for revision of a failed weight loss procedure. These choices include:

  • Bands above bypasses or previous stomach stapling
  • Revisions of bands
  • Endoscopic procedures to narrow a pouch such as StomaphyX
  • A revision gastric bypass surgery

In a revision operation, the prior operation is altered to most often a Gastric Bypass operation. A revision operation is considered a high risk operation even at the hands of most experienced weight loss surgeon. The main reason that revision surgery is considered high risk has to do with the scar tissue that forms from the original operation. This scar tissue is an expected result of any surgical manipulation. The Band above the bypass may decrease some risks of surgery but may cause long-term issues with erosion of the band through the pouch wall. The endoscopic procedures require general anesthesia but do not require a reoperation.

Because of the original manipulation, the stomach pouch is scarred densely to the surrounding organs, such as liver, spleen, pancreas and even the bypassed stomach. In order to "revise" the stomach pouch it is necessary to free up the scar tissue. It is possible to injure the surrounding organs during this process leading to greater bleeding complications. It is also possible to tear or perforate the pouch which needs revising, adding to difficulty in completing the operation.

Revision operations involve operating on a scarred and previously manipulated gastric pouch. Because scar tissue does not heal as reliably as tissue that's never been operated on before, the leak rate from revision surgery is 10 times higher or more, in comparison to the original surgery. A revision operation often results in greater chances of open operation, a longer hospital stay and longer recovery time for the patient.

Please discuss any of these options with your bariatric surgeon to help determine if a revision is needed and the best approach for long term health and wellness. Remember any weight loss surgery needs to be reinforced by lifestyle changes. In addition, visits to a clinic that provides the support is the key to long term success.

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