Revisional Surgery

Sometimes, weight loss operations do not work. You may not lose enough weight to improve your health, or you may regain weight.

If this is the case, you should make an appointment to see your surgeon. This may be a result of your behavior, but more importantly, it may be a result of the normal course of your operation. If this is the case, your surgeon may suggest that an operation to revise or change your operation would be helpful.

Weight regain after bariatric surgery is often devastating for the patient. It takes a lot of courage to have the surgery in the first place, and many patients feel they have let themselves down terribly. More often than not, though, it’s the operation that has let them down, rather than a weakness in the patient.

Here are the common operations, and what we at NYU can offer to help the patient get back what they have lost.

VBG (Vertical Banded Gastroplasty, AKA: Stomach stapling) : This was a very common operation in the 1980’s and 1990’s. The staple line is prone to stretching, and patients regain a lot of weight. The remedy is to convert to a gastric bypass. We have done many of these, and patients have been very happy with the result.

Roux-en Y Gastric Bypass : Over time, the pouch or the opening into the bypass may stretch to the point of allowing rapid passage of food out of your stomach pouch into your intestine. You may get hungry again, and lose restriction. Once this happens, you may feel like you are on your own, resorting to dieting, which simply doesn’t work. This is very common after bypass surgery, usually at 3 to 4 years out. The answer here is to have a lap band placed around the gastric pouch to reintroduce restriction, and control hunger. We have done over 60 of these, with excellent results. An alternative is to sleeve the bypass, which we have also performed.

Sleeve Gastrectomy: The sleeve is an excellent weight loss operation, but it can be prone to weight regain if the new stomach stretches, which it can do. Patients notice return of hunger, and loss of fullness, and then regain weight. There are several options available, all of which we have done – putting a band around the sleeve, convert the sleeve to a gastric bypass, or resleeve the stomach.

Lap Band : In our hands at NYU, about 5% of patients fail to lose weight with a lap band, or can’t tolerate the band, usually due to reflux when the band is tightened. We have performed both gastric bypass and sleeve gastrectomy in this setting. We do it at the same time we remove the band.

Lap Band previously removed: All options are available if you have had your band removed and regained your lost weight, which happens to almost everybody who has their band out. We have reinserted bands, done bypasses or performed sleeve gastrectomy for these patients.

BPDDS: Weight regain after BPDDS is uncommon, and best treated by resleeving the gastric pouch, which has usually dilated and is too big. Another option is to place a gastric band over  the pouch.
Revisional (or ‘re-do’) surgery is more complex than primary weight loss surgery (having it for the first time), due to adhesions and scar tissue from the original operation. Special experience is needed when handling these cases. We at NYU have one of the largest experiences in the USA with revisional surgery. Should you need it, you will be treated with compassion and understanding, by surgeons who are highly experienced in revisional surgery.