While many patients achieve successful results with their first bariatric surgery, for others the outcome is not as satisfactory. There are two major reasons patients seek revisional bariatric surgery. Some patients experience significant side effects or complications from an earlier bariatric surgery that are impacting quality of life and the other reason is when they do not achieve the expected rate of weight loss. If you have undergone a bariatric surgery procedure, you may have ceased to shed pounds before reaching your target weight, or have begun to notice an increase in weight gain again.
Most common revisional procedures performed are removal of gastric band with conversion to vertical sleeve gastrectomy or gastric bypass, vertical sleeve gastrectomy to gastric bypass, or duodenal switch. Also revision of gastric bypass pouch or creation of distal gastric bypass. All procedures are attempted to be done in one stage, however due to post-operative scarring, body habitus or patient’s health status at time of surgery, a small percentage of patients do need to have their revisional surgery completed in a two stage (two operations) process.
Consultation for these procedures will include a detailed conversation about qualification for these revisional procedures. Close work with nutrition counseling as well as incorporating moderate exercise programs will be attempted before discussion of these procedures. Again, if conservative measures have failed to assist in weight loss, revisional surgery will be discussed.
The same qualifications are needed for revisional surgery as are for the other procedures. Qualifications for this procedure involve a BMI (Body Mass Index) of greater than 40 or a BMI of 30-40 with obesity related conditions (sleep apnea, high cholesterol, high blood pressure or Diabetes Mellitus type II). A staged diet will be enforced once surgery dates are obtained. Two weeks prior to surgery a patient is placed on an all protein shake and clear liquid diet in order to increase weight loss and put a patient’s body into a state of ketosis. This is a normal metabolic process that happens when the body does not have carbohydrates coming in for energy and is forced to get energy from fat storage. For surgery this is especially important because fat storage is taken from the liver allowing for shrinkage in the liver. This will decrease the risk of injury to the liver as well as allow for the surgery to be safer, faster and more efficient.
Two weeks post-surgery the patient will be on an all clear liquid diet with one protein shake a day to allow for proper tissue healing and nutrition in preparation for slowly introducing food back into the diet. Week three will start the soft food portion and week 6 will allow for raw fruits and vegetables to be incorporated as well.
Patients are instructed on no heavy lifting greater then 20lbs after surgery, no driving for five days after surgery and are usually able to return to a sedentary type job within 1-2 weeks. Patients that partake in more rigorous work can discuss return to work options with the MD/PA on a one to one bases. Drinking from straws and drinking carbonated drinks are discouraged after surgery. Pregnancy is possible after bariatric surgery and encouraged to hold off until two years post surgery. This will allow ample time for efficient weight loss and adjustment to the new lifestyle.