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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, WeightWise 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:
1) 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.
2) 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).
3) While revisional operations can be effective, they are usually less effective than first-time operations – tend to lose less excess weight than “first-time” operations.
Why Revisional Procedures?
While bariatric surgery is commonplace and growing in popularity and use, there will be rare occasions when complications arise. In many cases, this is because the patient was unable to follow the prescribed post-op plan and either didn’t lose weight or even gained 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. As part of the pre-operational discussions that will be had with the surgeon, dieticians, exercise physiologists, and patient advocates. Even though the patient has already had bariatric surgery, the procedures remain the same at WeighWise.
If a patient has already had bariatric surgery, they should be familiar with the pre-op protocol. However, WeightWise 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, both before the initial surgery and after.
This is especially important if WeightWise 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.
The same holds true for our dietitians and exercise physiologists. We want to make sure you understand the necessary dietary restrictions as well as exercise requirements. The WeightWise staff 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, 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.
Weight Loss Expectations
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 WeightWise.
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.
According to research presented at the Society of American Gastrointestinal and Endoscopic Surgeons 2018 Annual Meeting, it was shown that revisional procedures managed to help those that still suffered from diabetes after initial bariatric surgery. These procedures include reversions as well.
Of the 123 cases studied where diabetes was persistent, conversion or revisional surgeries helped improve the disease by up to 70 percent and even caused diabetes to go into remission to nearly 30%. The success rate varied between initial surgeries and what the conversion procedure was.
For example, those who had originally gone with a vertical band gastroplasty and converted to a gastric bypass saw the best results. Converting to an adjustable lap band improved the disease by 50% and there was a 28% improvement for those who converted to a gastric sleeve.
Revisions of the gastric pouch or gastric sleeve saw improvements of 69% and a remission rate of 25%. So if there are lingering issues with diabetes after the initial bariatric surgery, there are procedures that can help. Of course, maintaining a strict diet and exercise are a must no matter what surgery you decide on. Surgery is just one piece of the weight loss puzzle.
Post Operation Information
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 dietitians 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. WeightWise 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 through a plan devised by your exercise physiologist.
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 WeightWise. Our surgeons will talk with you about the surgery, potential reasons why it didn’t work, and suggest a course of action. To learn more about us, please take a look at our FREE online seminar or contact us to set up an assessment.