Revisions for Failed Weight Loss Surgeries
Frequently Asked Questions that will help you understand why so many patients come to Dr. Patel for information on Failed Weight Loss Surgery Revisions.
> What problems are caused by failed weight loss surgery procedures?
> Why do some surgical weight loss procedures fail?
> What are the symptoms of a failed bariatric procedure?
> What is done during a weight loss surgery revision operation?
> How risky is the weight loss surgery revision operation?
> What type of results should I expect from the revision operation?
> How do I choose a revision surgeon?
> How can Texas Bariatric Specialists help me?
> How can I be helped if I live outside Texas?
What problems are caused by failed weight loss procedures?
When weight loss surgery procedures fail, they can result in significant metabolic and physiologic disturbances. They also can cause devastating psychological and emotional consequences, which often are the least recognized consequences following a failed operation.
Almost all patients who suffer from this problem have gone through the same cycle of emotions. After years of struggling with failed dieting attempts and severe obesity, they are accused of “taking the easy way out” by both family and friends alike when they seek surgical options. If the procedure begins to fail, their response is to blame the patient. The accusations start to fly, with some patients hearing degrading remarks such as “You couldn’t even do it with the surgery!” Unfortunately, these and other comments just add insult to injury.
At this most fragile point in time, many surgeons will also place the blame or fault on the patient without an adequate evaluation. Sadly, in the majority of cases patients will not find assistance from their primary surgeon. The typical search for a consulting surgeon to fix the failed weight loss surgery procedure can be heart-wrenching and seem endless since most surgeons aren’t willing to take on the difficulty of a revision surgery.
Typically, when another surgeon is finally found, a complete evaluation is then done. In many cases a mechanical issue is identified for the “failure” and a revision or correction is suggested. Every patient considering a revision procedure needs to know it is not without some amount of risk, and it requires more courage and support than the primary procedure itself. Fortunately, when a weight loss surgery revision is performed by a surgeon experienced in such procedures a much higher chance for success is enjoyed.
Why do some surgical weight loss procedures fail?
A surgical weight-loss procedure could fail for a number of reasons including:
- The patient regresses back to his/her “old habits,” and strays away from the recommended diet and exercise program
- Mechanical complications following an appropriately constructed operation; for example, “pouch stretching,” “slipped bands,” and/or “fistulas.”
- Failure happens due to the natural history of the procedure; for example, the vertical-banded gastroplasy or the jejunal-ileal bypass.
What are the symptoms of a failed bariatric procedure?
Below are the typical symptoms associated with four failed bariatric procedures. (Note: Some patients have different symptoms.) In all cases, be aware it’s normal to experience weight regain after initial success or a premature plateau in weight loss early after the procedure. If you think you may be experiencing a failed procedure, the first thing to do is to start a daily diary of your diet and exercise activity. Concurrently, contact your surgeon and nutritionist so they can rule out non-compliance; meaning that the procedure is failing because you’re not following “doctor’s orders” on what to do and what not to do after surgery.
Failure after a vertical-banded gastroplasty:
- High frequency of vomiting shortly after meals
- Decreased tolerance for solid foods (such as meats) and roughage (such as salad)
- Chronic unremitting reflux
- Non-healing ulcers found during an endoscopy
- Chronic epigastric pain (pain just below the breast bone)
- Increased capacity for food
Failure after a jejunal-ileal bypass:
Regardless of the symptoms a patient may or may not have, all jejunal-ileal bypasses should be reversed due to possible life-threatening liver failure. Individuals should always seek the guidance and services of an experienced bariatric surgeon to have this procedure done.
Failure after a laparoscopic adjustable band:
- Increased capacity for food despite numerous band “adjustments”
- High frequency of vomiting shortly after meals
- Decreased tolerance for solid foods (such as meats) and roughage (such as salad)
- Chronic unremitting reflux
- Non-healing ulcers found during an endoscopy
- Chronic epigastric pain (pain just below the breast bone)
Failure after gastric bypass:
- Development of frequent vomiting
- Increased capacity for food
- Refractory strictures
- Uncontrollable “dumping” of wastes
- Premature plateau in weight loss
The above list only represents the most frequently recognized symptoms; many others exist. That’s why it’s important for all patients to be followed closely by their primary bariatric surgeon. If such follow-up is not offered or no longer possible, it is imperative that patients seek an alternative surgeon.
Patients suffering from symptoms similar to those listed above, or who have had a significant change in the way they feel, should request a thorough post-procedure examination and evaluation by their surgeon. A second opinion may be necessary if the primary surgeon’s level of expertise is not extensive. Also, patients should not hesitate to seek alternative opinions if it’s believed the symptoms were not thoroughly evaluated, or have somehow changed.
What is done during a weight loss surgery revision operation?
Unfortunately, there is no “standard of care” when it comes to fixing failed bariatric procedures. This is because most surgeons do not have extensive experience in revising bariatric procedures. That’s why it is imperative that a patient choose a revision surgeon even more carefully than the original surgeon. During a revision, most experienced surgeons will take an evidence-based approach. Surgical options for a revision include:
- Vertical-banded gastroplasty a. Re-banding the gastroplasty b. Re-doing the vertical staple line c. Conversion to a gastric bypass
- Jejunal-ileal bypass a. Restoration of normal anatomy b. Conversion to a gastric bypass
- Laparoscopic adjustable gastric band a. Re-banding b. Conversion to a gastric bypass
- Gastric bypass a. Re-sizing the pouch b. Re-creating the gastrojejunostomy c. Lengthening the bypass d. Banding of the bypass
- Sleeve gastrectomy a. Conversion to SIPS (Stomach Intestinal Pylorus-Sparing Surgery)
As mentioned, there is no standard operation following a failed procedure. When taking an evidence-based approach, most surgeons agree that the gastric bypass is the best option following many failed procedures. They also agree that once a banding operation has failed (either a vertical banded gastroplasty or a laparoscopic adjustable band), the best surgical option is the gastric bypass. As far as the jejunal ileal bypass is concerned, the decision of restoration versus conversion to bypass is based on the patient’s desires and present weight.
How risky is the weight loss surgery revision operation?
In general, all revision operations are two to five times more risky than a primary operation. Whatever risks were quoted to a patient before his or her first operation should be adjusted to reflect this increased risk.
What are the expected results of a revision operation?
As ironic as it may sound, the main goal of a revision operation is to restore the patient’s ability to eat a well-balanced meal without distressing symptoms such as pain, nausea, and vomiting. In doing so, the secondary objective is to restore emotional and psychological health. Last but not least, the revision’s third objective is to achieve your goal weight. What this means is that failure to achieve a goal weight alone may not be enough to qualify for a revision. The risk associated with the procedure must be offset by the benefits. Most surgeons will agree that weight-loss should not be the only goal of the revision. Many patients don’t realize that after a revision, weight loss is generally slower, and the percentage of excess weight loss sustained is slightly lower than what is experienced after a primary weight loss surgery procedure.
How do I choose a revision surgeon?
After deciding to have a revision, perhaps the most critical step of the revision process is finding the right surgeon to do it. The bottom line on this is that your revision surgeon should be the most experienced doctor available to you. He should have performed an extensive number of revisions in the past, and provide you with their results without hesitation. Always seek a second opinion if your surgeon insists on re-banding a vertical banded gastroplasty or re-doing a laparoscopic adjustable band since the failure rate for these procedures may not be acceptable given the risk of the revision itself. This second opinion should be secured from someone other than your primary surgeon, and not in the same practice.
How can Texas Bariatric Specialists help me?
Our practice has extensive experience in “troubleshooting” procedures which are believed to have failed. After doing thorough evaluations, we’ve helped more than 90% of patients who have come to us experiencing symptoms and troubles following vertical-banded gastroplasties and laparoscopic bands. That amazing success rate should give you great comfort, peace of mind, and hope for an opportunity to regain your health. Click here to start a conversation with us about how we can help you.
How can I be helped if I live outside Texas?
You can still tap into our expertise in revising failed procedures if you don’t live in Texas. On a consultative basis our practice will review your files and x-rays to provide an expert opinion about your symptoms and underlying problem. Contact us today to set up a free phone consultation with a surgeon from Texas Bariatric Specialists. We can give you the professional assistance you’ve been seeking to help you reclaim your life!
Getting Started
Trusted, professional help with your weight loss surgery options are just one click or phone call away. We offer a variety of ways to help you regain your health and improve your quality of life.