Bariatric Revision Surgery: When Is It Right for Your Patient?

To help with chronic obesity and its many comorbidities, bariatric surgery is a powerful tool to lose weight and increase metabolic health. But as is the case with many diseases, people with obesity can experience relapses after treatment. When bariatric surgery is no longer effective, bariatric revision surgery can offer a solution.

Lehigh Valley Health Network (LVHN) is the area leader in bariatric revision – surgery that corrects or improves a previous weight-loss surgery. In fact, the network performs more than 1,000 bariatric procedures each year, of which more than 100 are bariatric revision procedures.

“Weight regain after initial bariatric surgery can happen for multiple reasons. At LVHN, we can improve the patient’s ‘tool’ to provide better weight loss, but education is important to gain maximum benefit from bariatric surgery,” says Richard Boorse, MD, Chief, Division of General Surgery. “We are geared to get them safely through surgery and follow the patient for up to five years postop to achieve long-term success.”

Individuals who benefit from bariatric revision include those who haven’t achieved optimal weight loss or have gained back substantial weight after surgery. Others may be experiencing unwanted side effects, such as gastroesophageal reflux.

“It’s important not to think of bariatric surgery in terms of success or failure,” Boorse says. “Obesity is a chronic disease. If we can prevent a patient from living with high blood pressure, type 2 diabetes, sleep apnea or other comorbidities for 10 years, that is a success.

The longer we ward off disease, the longer we can extend a patient’s life.”

LVHN performs minimally invasive Roux-en-Y gastric bypass and sleeve gastrectomy procedures, which work in different ways to reduce the size of the stomach and aid in weight loss.

Common revision surgeries include:

• Converting a gastric lap band (an older, less effective surgical approach to weight loss) to a sleeve gastrectomy or gastric bypass: This is done for better results and fewer complications. 
• Converting a sleeve gastrectomy to a gastric bypass: This often cures gastroesophageal reflux sometimes caused by a sleeve gastrectomy.
• Revising a gastric bypass: Individuals may see weight gain over time as the stomach “pouch” stretches and they lose restriction. Revising a gastric bypass reduces the size of the pouch and increases the restriction.

“Each type of bariatric surgery is different. What works for one person may not be appropriate for another,” Boorse says. “We conduct extensive imaging and evaluation to determine the best option for each patient.”

Bariatric surgery patients should be evaluated for revision surgery if they have:

• Gastroesophageal reflux
• Regained weight or never achieved adequate weight loss after surgery and have a body mass index of 35+ with comorbidities such as diabetes, high blood pressure or sleep apnea

Any individual who is struggling with weight gain after bariatric surgery but does not qualify for revision surgery can be referred for extensive supportive services with LVHN’s bariatric program.

“Just because a patient has had a relapse from bariatric surgery does not mean they will not achieve success,” Boorse says. “To fully address issues like diabetes and high blood pressure, we need to treat the root cause. Revision surgery can help.”