The thought of a weight loss surgery revision is probably a bit scary to those of you who are contemplating a procedure for the first time. Those who had bariatric surgery and it didn’t work, probably want to hear more about it. The whole diet and exercise thing put you on a roller coaster that ended in failure.

Sometimes a patient develops a problem after bariatric surgery or a patient fails to lose weight, and his or her procedure is revised to a different type of operation.

Some of the reasons for revisions are:

  • Unsatisfactory results with a procedure
  • Technical problem with the weight loss surgery
  • Difficulties with the current anatomy (adhesions, pain, bile reflux)

Considering a procedure to revise a previous bariatric surgery can bring back guilt feelings. After all, who wants to be the only one on the block, or in the support group, to be stigmatized by failing weight loss surgery? There are many reasons for bariatric surgery failure that have nothing to do with you at all.

When a patient regains pounds following weight loss surgery, a workup is done to find the reason the operation failed. There are two reasons for failure. If the reason was anatomical, we can fix it. If, however, all the anatomy is normal but the patient has re-gained pounds, then revision to another type of procedure is unlikely to provide weight loss. There is an unwritten rule in bariatric surgery. If someone has had two weight loss surgeries, both of which were “good” procedures with no obvious anatomical problem yet still does not lose pounds, he or she is not a candidate for a third procedure.

Revision have a higher incidence of all types of complications, from leak rate to infection. This procedure is not to be taken lightly, nor is it to be considered routine by any means. There are some weight loss surgeons who specialize in revisions and have a great deal of experience with certain types of revisions. One of the best is my friend, Robert Rabkin in San Francisco, who has a great deal of experience revising procedures to a duodenal switch.

Valid reasons for weight loss surgery revisions:

Jejunal ileal bypass (anyone who has this should have it taken down)

Opening between the upper and lower pouch

Stoma enlargement

Upper Pouch enlargement

Recurrent stomal stenosis

Protein malnutrition

Jejuno-ileal bypass revision

If you had a jejuno-ileal bypass procedure, The American Bariatric Society recommends a revision. It states in their website, http://www.asbs.org, “As a consequence of all these complications, jejuno-ileal bypass is no longer a recommended Bariatric Surgical Procedure. Indeed, the current recommendation for anyone who has undergone JIB and still has the operation intact, is to strongly consider having it taken down and converted to one of the gastric restrictive procedures.” This should be done even if you are maintaining a normal weight. Lap-band surgery is a good gastric restrictive procedure to use for weight loss surgery revision.

The jejuno-ileal bypass was the most common weight loss surgery done in the 1970’s. It produced dramatic weight loss, often 100 pounds in the first few months. There was no restrictive component of the disease, so patents could eat “anything,” and still lose pounds. Those weight loss surgery patients who didn’t change eating habits found that over a twenty-year period they regained their weight. But, that is not the reason that this procedure needs to be reversed.

Because calcium was not absorbed well and it complexed with oxalates, patients managed to get plenty of calcium kidney stones and not enough strong bones. It is not good to have more calcium in your kidneys than in your back. Because all but the last 35 centimeters of small bowel were bypassed, vitamin B12 deficiency was common, which lead to inadequate blood production, and thus anemia. Patients needed to have monthly shots of vitamin B12. But the most deadly consequence was liver disease. The malabsorption combined with high caloric intake combined to give patients non-alcoholic steatohepatitis (NASH). This led to liver cirrhosis and death from liver failure from the operation.

This operation has been revised successfully to all types of bariatric procedures. The earliest revisions were to VBG. Then Lap-band surgery became the procedure of choice.