Revisional Surgery

Revision Weight Loss Surgery is a surgical procedure that is performed on patients who have already undergone a form of bariatric surgery, and have either had complications from such surgery or have not successfully achieved significant weight loss results from the initial surgery. Procedures are usually performed laparoscopically, though open surgery may be required rarely if prior bariatric surgery has resulted in extensive scarring. With the increase in the number of weight loss surgeries performed every year, there are growing numbers of individuals. Since there is a failure of principle of primary surgery, the aim has to be to identify the reason for failure. If the failure is due to technical error, then revision can be redoing the same procedure. For eg. Resleeve can be a good option for a technically wrong primary sleeve. This can be identified by an endoscopy or a thin barium swallow study. If the failure of weight loss or weight regain is due to failed principle, then a procedure with another technique should ne offered to the patient. For eg. If there is a failure of a restrictive surgery (sleeve), then reoperation should be a malabsorptive procedure (Gastric bypass).

If a malabsorptive procedure fails, then careful investigation is a must to identify the reason for failure. If the failure is due to dilatation of the anastomotic stoma of the stomach, then reduction of the stoma can aid in additional excess weight loss. This can be best achieved by endoscopic method as described in stomal reduction under endoluminal section. If the failure is not due to dilatation and investigation proved no significant pathology, then a more distal malabsorptive limb has to be added or a more complex biliopancreatic diversion should be tried to help in better weight loss.