Different Types of Gastric Bypass Revision Procedures

Different Reasons You Need to Do Gastric Bypass Revision

Generally, there are two reasons why you will do gastric bypass revision:

  1. You experience problem with losing/gaining weight after your gastric bypass surgery.
  2. You experience some complications after surgery.

According to research, 20% morbidly obese patients and 35% super obese patients gain their weight back after 10 years. This phenomenon can be caused by internal issues, metabolic reasons or simply inappropriate eating habit.

The first step to find out the cause of failure of your gastric bypass surgery is to look at your eating habit. You can simply start your own food dairy or ask someone to help you. A lot of patients are often shocked after find out how many calories that they consume every day.

The next step is to adjust your eating behavior to the proper one. You can ask dietician or your surgeon to help devised plan for you. Some people manage to lose weight after this adjustment but some people fail and the rest fail to adjust their eating behavior.

Emotional issue could be another cause here. You should talk with your psychologist to find out if you have any emotional issue that affect your eating habit.

Mechanical Causes of Gastric Bypass Revision

There are also mechanical causes that could be the cause of your gastric bypass surgery failure:

  1. Gastro gastric fistula
  2. Pouch dilation
  3. Anastomotic dilation

Gastro gastric fistula is the situation where your stomach pouch grows back and re-connects to the bypassed stomach. This happens because your stomach pouch gets leak. The leak causes local inflammation and disrupts the staple line of the bypassed stomach. The revision surgery will close the fistula and restore the original surgical gastric bypass anatomy.

Pouch dilation is the situation where your stomach pouch stretches out and enlarges. This cause you eat more than prescribed quantity required to maintain your weight. Your surgeon will re-trim your stomach pouch to make it small again. Other approaches include surgical banding, endoscopic fixation, duodenal switch and Vertical Sleeve Gastrectomy based procedure.

Anastomotic dilation is the situation where the passage between stomach pouch and intestine stretches out.

Different Gastric Bypass Revision Procedures

1. Shrink The Stomach

This is common procedure used to treat pouch or anastomotic dilation. Your surgeon will inject a sclerosant to shrink the opening between your stomach and small intestine. The success rate is quite high with this procedure.

2. Make The Stomach Pouch Smaller By Using A Device

This is relatively new procedure where your surgeon will insert special tubes through the mouth, down the esophagus and into the stomach pouch. The aim is to create permanent folds around the stoma (the opening between your stomach and small intestine) and within the pouch.

The procedure can be divided into two types: ROSE procedure and StomaphyX procedure.

ROSE procedure or commonly called Revision Obesity Surgery Endoscopic is the procedure where your surgeon will form the folds manually utilizing special graspers and holds them in place with sutures and tissue anchors.

In the second procedure, StomachyX procedure, your surgeon will use special device that suctions the stomach skin fold in and insert an H-shaped fastener to hold the fold in place. This procedure is only used to reduce pouch size and not to shrink the stoma (the opening between your stomach and small intestine).

The cost for both procedures is around $8000 to $13,000 and it takes around 30 minutes to perform the procedures. Most patients can leave the hospital in a day or two after the surgery. The lack of incisions makes these procedures relatively safer compared with other methods. Most patients are able to return to their original post-surgery diet in 6 weeks after the procedures.

3. Adjustable Gastric Band

The insertion of adjustable gastric band is another common procedure used to treat failed gastric bypass surgery.

4. Lengthen the Roux Limb

This procedure is applied when the cause of your gastric bypass failure is a very low base metabolic rate. In this procedure, your surgeon will convert a proximal Roux-en-Y gastric bypass to distal Roux-en-Y gastric bypass. This procedure carries the highest risk compared with other methods. Therefore, many surgeons won’t recommend this procedure no matter what is the case of your failed gastric bypass surgery.

5. Duodenal Switch

If you super obese with body mass index 50+ prior to gastric bypass surgery, conversion to duodenal switch maybe the best option for you. According to one study, there were patients with an average original BMI of 53.9 experienced 63% excess weight loss after 1 year revision.