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Bypass Revision

At OCC, we understand that revising a failing surgery is unique and must be approached accordingly. After thousands of patients that have undergone weight loss revision surgery, we can consider ourselves leading experts in the field.

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Revising a Failed Bypass Procedure

It is a well-known fact that not everyone achieves long-lasting and successful weight loss with gastric bypass surgery (RYGB).  It is worth noting that every person submitted to bariatric surgery responds differently. There is no simple explanation since there is a long list of variables for each of the following: patient, procedure, surgeon, technique, follow-up, post-operative “problems,” etc. It’s fair to say that most patients experience an initial good weight loss response to the procedure. Many have long-lasting effects from the initial bypass surgery in maintaining successful weight loss. Successful weight loss is defined by keeping off over half of the excess weight at the time of operation. It is very worrisome for a gastric bypass patient when the weight starts to increase, or weight loss stops before achieving the expected goals. These issues can happen a few months or many years after the bypass.  These are the most common reasons why patients start looking into options to improve their outcomes.

How Bypass Revision Works

Before discussing revision options for RYGB, it is essential to note that the procedure works by combining two different mechanisms to achieve weight loss; one is malabsorption, and the other is restriction. Surgeons generate malabsorption by rerouting the intestine. This rerouting results in the food not passing through the first or proximal part of the gut, leading to less food absorption capability. Also, rerouting modifies intestinal hormones to improve weight loss outcomes.

The restriction mechanism or capacity to eat less food volume is generated by the small gastric pouch (20% capacity compared to a normal stomach) and its new outlet. This restriction happens when the intestine is jointed (anastomosed) with the gastric pouch, also known as a stoma. When we study RYGB patients for insufficient or regained weight, we evaluate both mechanisms. Doctors at Obesity Control Center perform revisions of one or both mechanisms. Still, we have to tailor to each individual after careful evaluation.

Talk With Our US-Based Coordinators Today!

Call 1 866-893-8005 or email us here to start your journey to revising your procedure. Learn how you can finally get the life you deserve with help of the Obesity Control Center.

Bypass Revision

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Three Basic Ways of Revising a Gastric Bypass

Revising a Gastric Bypass Through Increasing Restriction

Surgeons increase restriction through laparoscopic or endoscopic methods. Surgeons can also utilize endoscopic methods that require no incision and are performed with an upper endoscopy. These include the StomaPhyx and Rose procedures. Both create folds around the stoma (gastric pouch outlet), substantially reducing its diameter while also reducing the size of the stomach pouch. Patients report less weight loss and durability with this type of technique. Laparoscopic procedures to increase restriction are limited but more effective.  The one that stands out is the adjustable gastric band system (AGB) on top of the gastric pouch. It can be regulated or adjusted to achieve the restriction needed to lessen food volume intake and obtain more weight loss. 

At OCC, we have extensive experience placing adjustable gastric bands (AGBs) in gastric bypass surgery patients dating back to 2002. This is a safe revision option that yields excellent results. We routinely perform all gastric band adjustments under X-Ray, which has the advantage of generating adequate restriction and only requires two modifications. Rare chronic complications related to AGB, such as slippage (the band slips down on the stomach) or erosion (bans migrates to the inside of the stomach), are much lower in patients with a gastric bypass. At OCC, we are proud to report no complications in our accumulated 18 years of experience with this procedure. Close follow-up is necessary to obtain the best results possible.

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Revising a Gastric Bypass Through Increasing Malabsorption

We can increase malabsorption by diminishing the intestine’s length as food passes through for digestion and absorption. This procedure is associated with a higher surgical complication risk. Weight loss results with this technique are limited and not as predictable. Because malabsorption increases with this technique, the risk of malnourishment and chronic diarrhea increases.

Revising a Gastric Bypass Through Another Procedure

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Converting an Roux-en-Y gastric bypass (RYGB) to another procedure is not easy since it has to be reverted by establishing regular gastric continuity (the gastric pouch connects to the rest of the stomach).

The most effective procedure for weight loss after a failed RYGB is the Duodenal switch surgery. It has the advantage of better metabolic control for diabetes. It preserves the standard outlet “valve” of the stomach (the pylorus). It has a higher surgery complication risk that includes leakage and malnourishment, which can be severe in some cases. After we complete the reversion, the duodenal switch surgery can be performed simultaneously or at a second procedure. The duodenal switch involves shaping the stomach in a tubular fashion identical to a gastric sleeve, shortening the absorption area for nutrients.

Gastric Sleeve vs. Gastric Bypass

The Gastric Sleeve and Gastric Bypass are different procedures and work differently. They both have their pros and cons and this question is the one you would definitely want to discuss with the surgeon doing the procedure. We really like the least invasive procedure that can get you the best results. This is why we always recommend a sleeve before the bypass. You can always move up to a bypass from a sleeve but not the other way around.

Schedule Your Gastric Bypass Revision Procedure Today

Call 1 866-893-8005 or email us here to start your weight loss journey. Call one of our US-based coordinators and learn how you can get the life you’ve always wanted with the help of the Obesity Control Center.

References
  1.     S Brethauer, S Kothari, R Sudan, et al. Systematic review on reoperative bariatric surgery American Society for Metabolic and Bariatric Surgery Revision Task Force. Surg Obes Relat Dis 10 (2014) 952–972
  2.     Pedziwiatr M, et al. Revisional Gastric Bypass Is Inferior to Primary Gastric Bypass in Terms of Short- and Long-term Outcomes—Systematic Review and Meta-Analysis. Obes Surg 2018 volume 28, pages2083–2091
  3.     Tran DD. Revision of Roux-En-Y Gastric Bypass for Weight Regain: a Systematic Review of Techniques and Outcomes. Obes Surg 2016 Jul;26(7):1627-34

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