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Having bariatric surgery can be the beginning of a longer, healthier, and happier life for people with obesity, particularly those with complications from type 2 diabetes. However, in some cases, a second procedure is needed to achieve optimal results.
Patients typically seek revisional bariatric, or weight loss, surgery either because they didn’t lose their desired amount of weight or had a health problem related to their initial surgery. Revisional procedures often are performed as soon as a few years or as long as 20 years after a person’s first surgery.
We’ve successfully revised hundreds of patients’ bariatric surgeries at MedStar Washington Hospital Center. For example, one woman had a sleeve gastrectomy—when the stomach is minimized to 25 percent of its original size—after which she developed severe gastroesophageal reflux. To correct the issue, we converted her to gastric bypass anatomy, where we make changes to the stomach and small intestine to change the way patients absorb and digest food. The procedure relieved her symptoms overnight.
LISTEN: Dr. Shope discusses revisional weight loss surgery in the Medical Intel podcast.
Our program is certified through the Metabolic and Bariatric Surgery Quality Assurance Program (MBSAQIP), which is an acknowledgement of our exceptional bariatric surgery care. Not all hospitals and clinics do revisional bariatric surgery, because it requires expert care and experience. We have several fellowship-trained surgeons and two of us have been doing bariatric surgeries for more than 15 years.
The Best Candidates for Revisional Bariatric Surgery
Most patients we see for revisions are in their 50s or 60s, and many struggled with committing to healthier eating, exercising, or other necessary lifestyle changes before or after their initial surgery.
People who seek a revision to lose more weight should wait at least several years. Patients having a problem related to their initial procedure should seek evaluation and treatment right away. Make sure you speak to your insurance company to learn what it requires to cover a revisional weight loss surgery. Some insurance companies halt approval if the length of time between procedures is too short.
Patients who need additional surgery to keep off weight because of their diets or lack of exercise after #bariatricsurgery might require a second surgery, says Dr. Timothy Shope, via @MedStarWHC. Learn more: https://bit.ly/2EDsWsJ
How We Perform Revisional Surgeries
The technique we select depends greatly on how the previous procedure was performed. For example, many of our patients have had unsuccessful lap band procedures in the past. These surgeries involve an adjustable silicone band placed around the top of the stomach to restrict food consumption. For revisional surgery, we might remove the band and perform a sleeve gastrectomy or gastric bypass surgery. For an unsuccessful sleeve gastrectomy, we typically convert the digestive anatomy to gastric bypass surgery. If you had an unsuccessful gastric bypass procedure, revisions are limited. While we can lengthen the bypass and revise the two connections that are created for that procedure, it depends greatly on the patient’s specific issue. Make sure to speak to your doctor to discuss your options.
What Should Patients Expect After Surgery?
Following a revisional weight loss surgery, patients must follow a healthy diet and exercise regularly to achieve optimal results. In the first month after surgery, patients' diets progress from liquids to soft foods. Eventually (usually by four to eight weeks) they progress to a regular consistency diet that focuses on lean proteins and non-starchy vegetables. Other foods, such as fruits and whole grains, can also be included. Patients should have a consistent exercise regimen that includes at least 30 minutes of cardiovascular exercise most days of the week and strength training at least twice a week.
We also suggest patients take advantage of follow-up care. Fifteen to 20 years ago, hospitals would have patients come in and receive a brief preoperative counseling before surgery. The surgeon would see the patient once or twice postoperatively, then the patient was essentially on their own.
Today, follow-up care typically consists of visits with a bariatric program where the medical team ensures patients experienced optimal weight loss and monitor them for any nutritional deficiencies. We typically see patients who have had weight loss surgery within two weeks of their surgery for their first post-operative visit. The patient will meet with both the surgeon and the dietitian and likely will get advanced to soft foods at that time. Typically, patients will follow up with the surgeon about one month later and are encouraged to schedule an appointment with a dietitian to ensure they are meeting their nutritional needs. Patients then come in about every three months during the first year, every six months in the second year, and then at least annually after that.
In circumstances in which patients don’t receive optimal results with bariatric surgery, revisional surgery can help correct their problems.