Some patients who undergo weight loss surgery experience a relapse many years later. The extent of their obesity relapses depends on what procedure they had. Revision surgery is an additional procedure that can help these individuals lose weight and address specific conditions.
Weight regain can be caused by many factors. Because the patient’s anatomy has changed and requires repair, revision surgery may be necessary. Dr. Jason Balette of The Woodlands’ Balette Bariatric Center of The Woodlands says that patients also come to us because they have gained weight due to changes in their behavior or new stressors. “Others who have had gastric bands procedures now see their family or friends getting better results from the sleeve gastrectomy or gastric bypass. They want these benefits.”
This interview features Dr. Balette discussing when and how revision can be helpful.
Why is it that some people gain weight again and decide to have another operation?
Life happens. Many people experience weight gain after bariatric surgery. If you have had children, divorced, changed your eating habits, lost your job, or stopped exercising, it is possible to regain the weight. Attitude and circumstances play an important role. My patients often hear me say, “The shape and size of your stomach are less important than the shape and size of your mind.”
Obesity can be a chronic condition. Weight loss surgery may save your life, but it is not a cure. Your ability to adhere to certain nutrition and lifestyle guidelines will determine your success.
When my patients lose ground, I ask them for a review of their current situation. We then discuss ways they can bring them back into balance. Before discussing further surgery, it is important to address lifestyle issues. It is important to determine if people are eating healthy foods, exercising regularly, and following a healthy lifestyle. That’s where we begin.
Some people lose weight due to anatomical reasons. If your stomach has swelled, you might be able to have revision surgery. It is not a failure. We expect your stomach to continue to grow over time.
Our experience as surgeons also helps us to learn. We can now do things that were impossible ten years ago. Some patients ask us for new procedures that will help them lose weight quicker.
What are your options when revision surgery is required?
It all depends on your personal situation and the type of surgery you had. To assess the shape of your anatomy, we will usually start with an esophagram. This is an x-ray taken of the stomach and esophagus. We can then determine which options are best for you once we have all the information.
We most often do revisions for patients who have had a Lap-Band (a silicone band that adjusts to limit food intake) before.
This surgery was extremely popular up until a few decades ago, but now about a third need additional surgery to lose weight. The reason is that the band has become looser or slipping over time. You may be a candidate for revision to a Sleeve Gastrectomy or a Gastric Bypass if you fall into this category.
Sleeve gastrectomy involves removing a portion or all of the stomach and reducing its size to create a tube-like structure. Patients tend to eat less because of both the small stomach and changes in hormones that affect appetite.
Gastric bypass involves dividing the stomach into two parts. One pouch is used to process food, and another pouch is used to bypass it. The pouch is connected to the small intestine. The stomach will become smaller after this operation. There are also hormonal changes that affect appetite.
These weight-loss operations are particularly effective in reducing diabetes because of hormonal changes following sleeve or gastric bypass.
Gastric bypass redirects acid and bile away from the stomach, which is an effective treatment for heartburn.
How can you select the right surgery for each patient?
It all depends on how successful your first operation was. Let’s begin with the Lap-Band. This band has the highest rate for revision.
Sometimes, the removal of the band can be done in one step. It is better to allow scar tissue to heal before proceeding with a sleeve/bypass a few months later. A bypass can be used to treat scar tissue. This is especially true if there is significant scarring.
We also consider the likelihood that a patient will develop acid reflux. This problem affects 20% of patients who have sleeved. To minimize reflux, we need to make sure that the sleeve is properly shaped. Much depends on the skill of the surgeon. It’s crucial to visit a center such as ours that has extensive experience in revision surgeries.
Are you able to perform revisions following the bypass and sleeve operations?
Yes, but not as frequently. Research has shown that the stomach volume can double two years after the sleeve surgery. This is natural and not the fault of anyone. Some patients eat more as their stomachs expand. These patients may be able to benefit from a revision. There are two options: re-sleeving or conversion to bypass.
For those with reflux, a conversion to a gastric bypass can be especially effective. The bypass would help both the reflux and weight loss.
However, the duodenal switch, which combines the gastric sleeve with a bypass of the intestines, has shown the greatest weight loss. There is a higher risk of vitamin deficiencies due to the bypass of certain intestines. Patients should take vitamin supplements on a regular basis and continue to follow up with their care team.
The duodenal switch was performed for patients with high BMI years ago. Because this surgery is time-consuming, surgeons began to perform it in two stages. They did so several months apart. After initial weight loss, the surgeon performed the sleeve-gastrectomy first. Then, the surgeon did the intestinal bypass. Many patients experienced such positive results with the sleeve that they didn’t need to go through the second step. We can now complete the duodenal switching if sleeve patients need to lose more weight.
In some cases, we may also consider re-sleeving–trimming a portion for the stomach that has re-expanded to create a smaller tube or sleeve.
A stapled reduction of the pouch is another option, also known as “sleeving your bypass”. This involves removing a portion from the pouch and reducing its size. It also restricts the food that a patient can consume.
Another option is to remove even more of your intestines so that patients consume fewer calories.
Endoscopic repair is a fourth option. We can tighten the stomach-intestine connection without making incisions. This will make it more restrictive and limit the amount of food you can eat. Although this is a promising approach, we are not yet sure how long it will last.
What types of revision surgeries are covered by insurance?
Different requirements apply to different insurance companies, but most will cover revisions to the band and sleeves to treat weight regain. Endoscopic revision is not covered.
How long does it take to recover from revision surgery?
Because revisions involve scar tissue and altering blood supply, it can take a few days longer than the original surgery. To be closely monitored, you may need to remain in the hospital for up to three days. Most patients return to their normal lives within a few weeks.
What results are you seeing after these procedures?
We have had very positive outcomes. A gastric bypass was a procedure that I performed on a middle-aged man. It involved a gastric sleeve. He has a new lease of life, he lost weight and his reflux disappeared. This surgery is used by many patients to give them a second chance.
What makes Balette Bariatric Center the premier center for revision surgery in The Woodlands & Houston?
We need to look at everything when people gain weight. Relapses can be caused by genetics, lifestyle, food choices, behavior patterns, and new life stressors. These factors are addressed first. Revision surgery is more likely to succeed if these factors are addressed first. We are known for our surgical expertise and receive many referrals for these reoperations.
The Balette Bariatric Center in The Woodlands is a multidisciplinary team that provides high-quality patient care. Our mission is to guide patients through difficult times so that they can take control of their lives.
Learn more about all of the weight loss surgery options we offer:
Contact our offices in Houston & The Woodlands to schedule your consultation – (281) 419-8400.