REVISIONAL SURGERY
Prior to any discussion of revisional (or redo) surgery, we must define “failure” of primary bariatric surgery. The generally-accepted definition of success after any primary bariatric operation is: maintenance of ³ 50% excess body weight loss (EWL) more than three years after the surgery. In other words: If you are 100 pounds over your ideal body weight (Metropolitan Life Insurance Table), maintaining a 50-pound weight loss five years after gastric bypass or adjustable gastric banding is a success. However, pure weight loss should not be the sole criterion for determining the need for revision of a “failed” operation.
Resolution (off medication), or remission, of serious health issues (i.e. type II diabetes, hypertension, or hyperlipidemia), increased mobility, and improved quality-of-life after surgery must also be considered. In other words, having a discussion of “realistic expectations” for bariatric surgery is critical. In our program, this discussion is crucial prior to entrance into our “Back-on-Track” or “Revisional” programs.
BACK ON TRACK PROGRAM
This program is designed to help postoperative patients who have regained weight or are struggling with change in eating habits, food as an addiction, psychosocial issues related to bariatric surgery and weight loss, frustration with the Band, or many other issues. Components of the Program include:
► Monthly visits with our Nutritionist
► Psychosocial counseling visits with our staff as needed
► Structured diets
► Specific Support Groups for post-op gastric bypass or adjustable gastric band patients-generally >
one-year post-op
► Specific Exercise Classes and Programs
► Medication support
► Consideration for revisional surgery based on results of program
REVISIONAL SURGERY PROGRAM
► Attend a minimum of three nutritional visits, every month, with our nutritionist
► Attend a minimum of three visits with our psychosocial counseling staff
► Attend required exercise classes and document plan for long-term incorporation of exercise into your
lifestyle
► Mandatory attendance at least two Support Groups (Back-on-Track groups) OR referred from Back-on-
Track Program
Patients who have had previous Roux-Y gastric bypass procedures and are candidates for revision (through either program above) will be considered for the following:
*If the gastric pouch is noted to be enlarged on Upper GI barium x-ray or Upper Endoscopy, I would revise
the pouch by reducing its size;
*If the gastrojejunostomy stoma is dilated, or enlarged, I use an Adjustable Gastric Band to band the outlet
or stoma. The adjustability of the Band allows true calibration of the stoma size. Stoma size is judged
by preoperative endoscopy.
*Often, both procedures are performed together due to an enlarged pouch and dilated stoma.
*Occasionally, neither the pouch nor the stoma are enlarged and consideration would be given to
conversion to a long-limb gastric bypass (increasing the length of the Roux limb, decreasing the length of
the common channel) after more extensive evaluation, including hormonal studies.
* All revisional procedures are performed laparoscopically. Only occasionally does the excessive
amount of scar tissue require an open procedure.
Patients who have had adjustable gastric banding procedures and are candidates for conversion or
revision (based on evaluation and compliance with either program above) will be considered for the following:
*If the Band is not of the new generation high volume, low pressure balloons, it can be replaced with a
new generation Band.
*The Band can be removed and a Roux-Y gastric bypass performed.
*These revisional procedures would also be performed using the Laparoscopic approach.
SPECIAL CIRCUMSTANCES
Patients who have had Vertical Banded Gastroplasties and require revision would be converted to Roux-Y gastric bypass.
There are other special circumstances which require individualized treatment and surgical solutions.