Revision surgery after primary bariatric consultation

What is it revision surgery after primary bariatric consultation?

Bariatric surgery is performed frequently for obese, morbidly obese and super obese patients.

This surgery may need revision due to the following:

1. Complications of the primary surgery
2. Failure to lose adequate/expected weight
3. Putting on weight after initial successful weight loss

How does revision surgery after primary bariatric consultation work?

For patients who had complications of primary surgery this will depend on the severity and the time period from the primary procedure.

Common gastric band problems that need revisional surgery will be:

• Slippage
• Erosion
• Infection
• Port site problems.

Almost always these will need elective revision surgery.

Gastric bypass and gastric sleeve problems that may need revision surgery are:

• Bleeding
• Leak
• Stricture
• Internal hernia.

Failure to lose adequate weight or putting on weight following adequate initial weight loss is another area that can be rectified by revisional/further surgery.

This will depend on the nature of the primary surgery and results of further investigations.

Usually there are a few investigations that need to be done in the form of gastroscopy, barium study and possibly different types of scans.

Once the cause of the problem is identified a further surgical procedure may be possible to rectify the problem.  In rare occasions there may be the need for more than one procedure.

How safe is the procedure?

Like any surgery there is a minor risk of side effects and complications and these will be discussed with you in full by your treating consultant prior to surgery.

The following are some of the examples of revision surgery:

1. Patients who have a gastric band in the long term may get band slippage, band erosion or leakage from the band system. All these problems will require further surgical intervention after an initial clinical assessment and investigation.
   For band slippage the band may be repositioned or unbuckled or in severe cases where the stomach is affected, the band can be removed.  In cases of band erosion the stomach will be incised and the band removed together with the port system.  If there is any leakage from the band then the whole band system will be removed and the surgeon and the patient may elect to insert another band.
2. In cases of inadequate weight loss or regain of weight after initial weight loss following gastric bypass one of the causes may be pouch dilatation.  Further surgery to decrease the size of the pouch can be offered.  Another rare problem of gastric bypass is stomal ulceration. This also needs to be excised and the anastamosis between the small bowel and pouch should be rejoined.                                           
3. Patients having sleeve gastrectomy may develop a structure in the sleeve that will need dilatation endoscopically.  If there is a leak from the sleeve then surgical intervention is likely to be the solution for this problem.

There are a variety of options and these are some examples.

What is the benefit?

The benefit of revision surgery is to assist in losing weight and to treat or prevent co-morbidities which are associated with morbid and super obesity.