What Is Revision Surgery?

Weight-loss surgery is a safe, effective and long-term solution to the problem of obesity. However, there are times when it becomes necessary to re-operate, whether because the original surgery was unsuccessful or a problem needs to be corrected. Second and subsequent surgeries after an initial bariatric procedure are known as revision surgeries.

Types of Revision Surgery

The American Society for Metabolic and Bariatric Surgery (ASMBS) classifies revision surgery into three types:

  • Conversion procedures are aimed at changing the original surgery into a different type. An example of a conversion procedure is removing an adjustable gastric band and performing a sleeve gastrectomy.
  • Corrective procedures modify the original surgery to make it more effective or to eliminate a problem with it. For example, modifications to a Roux-en-Y gastric bypass are considered corrective.
  • Reversal procedures restore the original gastric anatomy, such as removing an adjustable gastric band.

Why Perform Revision Surgeries?

As stated, weight-loss surgery is, on the whole, very safe and effective. However, there are times when patients’ weight loss goals are not met, and sometimes complications such as leakage, ulcers, pouch expansion or gastroesophageal reflux disease (GERD) do happen. In such cases, a revision surgery may be necessary.

Gastric bypass revisions may be performed due to:

  • Bleeding
  • Fistula
  • Inadequate weight loss
  • Leakage
  • Obstruction
  • Ulcer
  • Re-emergence of weight-related conditions like type 2 diabetes or heart disease
  • Weight gain

Most gastric bypass revisions are corrective, rather than a conversion or a reversal.

Adjustable gastric band revisions may be performed because of:

  • Band migration
  • Band slippage
  • Erosion
  • GERD
  • Port or tubing problems
  • Pouch dilation
  • Weight gain
  • Weight-related comorbidities

One of the main advantages of adjustable gastric banding is that it is relatively easy to reverse. The surgery can also be converted to gastric bypass, gastric sleeve or biliopancreatic diversion with duodenal switch (BPD/DS).

Sleeve gastrectomy revisions may be necessary due to:

  • Fistula
  • GERD
  • Leakage
  • Obstructions or strictures

Sleeve gastrectomies are rarely revised due to insufficient weight loss, subsequent weight gain or the reappearance of weight-related health problems. Sleeve gastrectomies that lead to severe fistulas can be converted into various types of jejunostomies, which involve opening up a hole in the stomach through the surface skin of the abdomen and the wall of the small intestines (jejunum).

Patients who develop worsening gastric reflux or heartburn from their sleeve gastrectomy may be candidates for conversion to gastric bypass. This conversion usually eases these symptoms by rerouting the acid and bile streams to an area of the intestines that is further down from the esophagus.

BPD/DS may be revised to correct the following problems:

  • Bleeding
  • GERD
  • Leaks
  • Malnutrition
  • Obstructions or strictures

Risks of Not Having Revision Surgery

The obvious risk of not going through with revision surgery is that the problem that makes revision surgery necessary will not be corrected, such as a health complication like GERD or a weight-loss issue. While bariatric surgery is a safe and effective treatment for obesity, it is not a cure. Some patients will regain some of the weight they lost after bariatric surgery. In such cases, a revision may help bring the weight down.

Recovery from Revision Surgery

Recovery from revision surgery is much the same as recovery from the initial procedure. According to a 2014 study published in the Journal of Gastroenterological Surgery, hospital stays were slightly longer after a revision surgery than after an initial surgery. Weight loss was slightly lower after revision surgery than after initial surgery, as well. However, hospital stays were still short and weight loss was still strong, making revision surgery an effective and viable option for certain patients who are unhappy with the results of their initial surgery.

Risks of Revision Surgery

Revision surgery, while very safe, is associated with a slightly higher rate of complications than initial surgery, according to a 2010 study published in Archives of Surgery. The study followed 56 people who underwent revision surgery. There was an approximately 33 percent rate of severe complications following the revision surgery, but no deaths.

“Although revisional bariatric surgery is associated with higher risk of perioperative complications compared with the primary procedures, it appears to be safe and effective when performed in experienced centers,” the study’s authors concluded.

About Advanced Surgeons

Advanced Surgeons is made up of some of the pioneers in gastric weight-loss procedures. With decades of combined experience among them, the surgeons and staff ensure the highest quality compassionate care coupled while using only the latest advancements in tools and techniques in the industry.

For more information on revision surgery or to schedule an appointment with one of our specialists, contact us today.