Gastric bypass surgery allows you to get rid of excess weight, whether due to lack of results following a healthy lifestyle change, or because you have a genetic reason for your obesity. It is highly effective for most patients, though some experience lack of results and then need to go back to their surgeon for gastric bypass revision surgery. There are a total of five common procedures performed if you need to get revision surgery, each of which are done differently and offer a different set of risks. Here is some information about this procedure, why it is necessary and how it is performed.
What is Gastric Bypass Revision Surgery?
Gastric bypass revision surgery is a type of procedure performed after you have already have gastric bypass. It is meant to help you get results when the gastric procedure alone did not offer the results you were looking for. This is typically either due to not losing the weight you wanted or gaining the weight back, or from various medical complications. While gastric bypass is a safe procedure, some patients do experience minor complications and need the revision surgery.
The gastric bypass revision procedure will reduce the size of your pouch even more so than what it was at previously. This minimizes how much food you are able to eat during each meal and helps you feel full for longer periods of time. It also helps your stomach to drain food at a slower pace, which extends how long you feel full.
When is it Needed?
Most people, who request gastric bypass revision surgery, do so because of their weight. They aren’t losing surgery as much as they imagined, or not at all or perhaps have gained a good deal of weight back. According to a study that appeared in Annals of Surgery in 2006, 35 percent of super obese patients and 20 percent of morbidly obese patients who got the gastric bypass procedure gained back at least 50 percent of their weight after the 10-year mark. There are different reasons for this, including not following the right diet or exercise routine, genetic factors or otherwise. Additionally, some patients get the procedure revised later on because of medical complications with the surgery or internal issues.
Tips for Determining When it is Necessary
Just because you have not been experiencing the expected results from your procedure, doesn’t necessarily mean you should get the revision procedure. Your doctor will first want to rule out other reasons for not losing weight or gaining some weight back, and determine if you are a good candidate for the gastric bypass revision surgery. Here are the questions and tests your doctor will perform:
Looking at Your Diet – The first most obvious thing to rule out is your diet. Start keeping a food journal now of what you have been eating, and be as honest as you can. Write down every bite of food, including drinks, that you consume on any given day. While it may be hard to write down less healthy foods you’re eating, it is going to help you and your doctor find the right path. If your diet looks to be to blame, changing that first is going to avoid an expensive, and possibly unnecessary, procedure.
Ruling Out Insufficient Exercise – After your gastric bypass procedure, diet and exercise are equally important. Just cutting back on your food intake and improving the types of foods you eat isn’t enough to lose excess weight and take it off. Part of your post-surgery instruction is to get a moderate amount of exercise as soon as your body healed from the procedure. Your doctor also wants to look at what types of exercises you have been doing, the intensity and how often, since having the gastric bypass procedure. One test that helps you create a good exercise plan is called an indirect calorimeter. This is a digital device that tests your basic metabolic rate (BMR). Your BMR is a calculation of how much energy your body burns during resting time.
If you are found to have a low BMR rate, then you will need to adjust your exercise properly, with the help of a personal trainer. If your doctor finds that you have a low BMR result, he or she is going to recommend changing your fitness routine for a few months, before continuing with the gastric bypass revision surgery. In this case, lack of proper exercise is likely the result of you not losing weight like you hoped.
Tests to be Performed:
After figuring out where you are with diet and exercise, your doctor will want to perform a few tests. These tests look for other potential causes of your lack of results, to finally figure out if the revision surgery is right for you. There are three types of tests, including an Endoscopy, Upper Gastrointestinal Tract Radiography, and Eating test.
Endoscopy – The endoscopy numbs you with medication, and then places a tube into your mouth and down your esophagus. It is able to look into your stomach to see the size of your stoma and pouch.
Upper GI – The upper gastrointestinal tract radiography (Upper GI) is a test that looks at your digestive tract in motion. You will first drink a colored dye and in the meantime, have x-rays done to see how you are digesting it.
Eating Test – Finally, there is the eating test. His test measures how much food you are able to eat before you start feeling full, and essentially shows if the gastric bypass was effective or not.
Types of Gastric Bypass Revision Surgeries
If your doctor has decided you are a good candidate for the gastric bypass revision surgery, it will be done with one of five types of surgeries: shrinking the stoma, doing lap band surgery, reducing the size of the pouch, lengthening the Roux limb, or using a duodenal switch. Here is more information about each type of procedure:
- Shrinking the Stoma
The first gastric bypass revision surgery procedure is done by shrinking the stoma. This is done with an injection called sclerosant, in a procedure known as sclerotherapy. Sclerosant is made up of sodium morrhuate and is injected into the stoma, which is the space between your stomach and small intestine. If the problem with your procedure was the dilation of your stoma, this injection can help. Usually it requires 2-3 injections over a period of time. In the August 2007 issue of Gastrointestinal Endoscopy, there was a study performed on potential weight gain after bariatric procedures. It found that the average patient who got these injections lost at least 10 more pounds in 6 months. There are minor complications possible, including abdominal pain, bleeding and small ulcers.
- Lap Band Surgery
The next possibility is lap ban surgery, which adds an adjustable gastric band. This is one of the types of weight loss surgeries, and lets your surgeon convert your procedure to the lap band. The lap band is a small band wrapped around part of your stomach to create a small section, similar to your gastric bypass surgery. A study for the Surgery for Obesity and Related Diseases appearing in the January 2010 issue, found that about 47 percent of a selection of 22 patients lost weight after switching to lap band surgery.
- Reduce the Pouch Size
If your doctor finds that the size of your pouch needs to be made smaller, they may do so with either a ROSE procedure or a StomaphyX procedure. Both of these tighten your stomach with tubes going down the esophagus, so they are minimally invasive. The ROSE procedure, which stands for revision obesity surgery endoscopic, uses a simple procedure for narrowing your stoma. It costs between $8,000 and $13,000. The StomaphyX is another option and works in a similar manner as the ROSE procedure. This is also $8,000 to $13,000. Each of these procedures takes less than n hour and you can usually leave the day of your surgery.
- Lengthening the Roux limb
This procedure takes your original proximal Roux-en-Y gastric procedure and converts it to a distal Roux-en-Y procedure, with a longer Roux limb. It is typically only done on patients that show a low BMR and lack of weight loss, regardless of their dieting and fitness regimen. This procedure has the most risks, including a 15 percent chance of leaking, according to a study in the February 2008 issue of Department of Surgery.
- Duodenal Switch
The last type of gastric bypass revision surgery is converting your bypass to a duodenal switch. If you were at the super obese level or someone with a BMI at 50 or higher, you may need the duodenal switch procedure. This procedure restricts how much food you’re able to eat and changes the calorie malabsorption in your body.
These gastric bypass revision procedures have the potential to help you lose weight with minimal risks. If you have found that after months or years of your gastric bypass, you’re not getting results anymore, consult your doctor about your options.