The most common revision for weight loss surgery failure is reduction in the size of the stomach. If the stomach becomes too large following weight loss surgery patients will not lose the pounds as they should. Revising the stomach to a smaller size frequently allows the patient to get off a plateau and begin losing the pounds again.
Duodenal switch and bilio-pancreatic diversion revisions
The size of the common channel is about 100 cm for most procedures. In the early days, some weight loss surgeons made this channel about 75 cm long and some of those patients developed severe protein wasting. This required the patients to undergo a lengthening of the common channel to allow more absorption of protein. It is rare to have a common channel revised to a smaller length. The stomach might be revised instead. Lap-band surgery is a modern safer solution requiring no further surgical alteration to the stomach.
There are two reasons for a DS revision. One is if the common channel has been made too short, leading to protein malnutrition. The other is if the stomach en-larges, allowing unsatisfactory performance.
Revisions from Vertical Banded Gastroplasty (VBG) weight loss surgery
Patents who develop severe heartburn and a large upper pouch need revision. Generally the upper pouch becomes so large that it can block the stoma outlet, which only causes the upper pouch to become larger and cause more severe heartburn. Revision to a Gastric Sleeve or RNY cures this problem almost immediately. Revision of a VBG to Gastric Sleeve, RNY or DS is not difficult, and is often the next revision for those who were unable to lose pounds with the VBG. The Gastric Sleeve is actually a Duodenal Switch without the gastric bypass, and is the most modern and preferred procedure.
This Is Not A Walk In The Park
There are more complications with revision operations than the first weight loss surgery. It takes longer, has more blood loss, and has a higher incidence of leaks, pulmonary embolism, and every other complication. These procedures are not performed by every bariatric surgeon, and if your surgeon is uncomfortable with these operations and wishes you to go to another, please listen to him.