When is revisional bariatric surgery required?

Bariatric surgical procedures often produce amazing results for patients who have struggled to lose weight for a long time. However, some people find that the results do not last and they regain the weight. In his latest article, highly-esteemed general surgeon Mr Michael Van den Bossche explains what patients’ options are if the find this to be the case.

What are the most effective surgical options to treat weight regain after failed weight loss surgery?

This is quite a tricky question because I differentiate between two sets of patients. There are patients who had restrictive surgery in the past, for example, a gastric band or a sleeve gastrectomy. Then there are patients who underwent an operation with an element of malabsorption, such as a gastric bypass. So for patients who regained weight after restrictive surgery, I tend to recommend an operation that induces restriction to give them the best possible weight loss.

For patients who regained weight after a gastric bypass procedure, we can do a distalization of the bypass, but the results of this are not always great. One also has to be very wary of inducing nutritional deficiencies, if there is too much malabsorption.  

Do these surgical options have a high success rate?

It's important to realize that the success rate of weight loss revision procedures is often not as high as the primary operation. This is especially true for people who had a previous gastric bypass procedure. The success rate is higher for patients who have a failed band or a failed gastric sleeve.

What are the main risks involved?

In general, the risks of revisional surgery are the same as the primary operation. They include bleeding, infection, deep venous thrombosis, pulmonary embolism, injury to internal organs, and a leak from an anastomosis, stomach or bowel.

In my experience, I think the risk is the same as our primary procedures, but it is generally accepted that if procedures are very difficult with lots of adhesions encountered, then there is a slightly higher risk of a postoperative complication. In general, the risk remains very low in expert hands.

What is the recovery time like after these surgeries?

In general, the recovery is the same as after the primary procedure. Patients are usually back to work within two weeks. The recovery really depends on the amount of damage to the abdominal wall. If the revision operation can be done with keyhole surgery, recovery is quick.

If for whatever reason, one has to resort to a bigger incision, a laparotomy, then of course recovery will take a few more weeks.

How common is it for failed weight loss surgery to occur?

Well, weight regain after bariatric surgery is actually quite common.

It is known that gastric bands have a failure rate of 50% within five years. There are various reasons that people regain weight or need to have their band removed. For example, the band may be empty because it causes swallowing difficulties, or it may cause significant reflux. Often patients develop something we call maladaptive eating behaviour, which means they survive on unhealthy food, because they cannot eat healthy food.

People with gastric bypass surgery can also regain weight, and this occurs in approximately 25 to 30% of patients, which is quite significant. Sleeve gastrectomy patients can also regain weight, especially patients who underwent the procedure many years ago, and the technique was not refined, meaning the gastric tube was often made too wide.

Mr Michael Van den Bossche is a leading general surgeon based in Southampton, Guernsey and Jersey, who specialises in a wide range of bariatric procedures. If you would like to book a consultation with Mr Van Den Bossche, you can do so today via his Top Doctors profile.