As gastric surgeries are gaining more recognition, we are constantly learning about newer types of surgeries done in the past that may need revision or changes done in order to help patients achieve their desired goals. Those who had their surgery performed in the past and experienced significant weight increase, major problems or complications may be in need of requiring another weight loss surgery abroad. Revision weight loss surgery is more complicated and poses more danger than the original surgery. Therefore, due to this, necessary knowledge regarding nutrition should be gained before the revision surgery and required tests performed. Your surgeon must have exact details about your health state to minimize the risks and postoperative complications. After finishing the workup which includes imaging, upper endoscopies, appointments with the dietician, swallowing studies, the decision should be made as a collective group.
Table of contents
- 1 Definition of safe revision gastric surgery
- 2 Candidate for a Revision Bariatric Surgery – when the revision surgery is necessary?
- 3 Reasons for revision gastric sleeve
- 4 Gastric sleeve revisional surgeries
- 5 Safe revision surgery for gastric bypass
- 5.1 Duodenal Switch
- 5.2 Mini Gastric Bypass- single anastomosis gastric bypass
- 5.3 StomaphyX
- 5.4 Transoral ROSE ( Restorative Obesity Surgery)
- 5.5 Transoral Outlet Reduction (TORe)
- 5.6 Shrink the soma by injecting a sclerosant (sclerotherapy)
- 5.7 Addition of adjustable gastric band (lap band surgery)
- 5.8 Lengthen the Roux limb
- 6 Lap Band revision surgery
- 7 Dangers after revision surgery abroad
- 8 Revision Gastric Surgery recovery time
Definition of safe revision gastric surgery
Revision gastric surgery in Poland is a procedure which is mainly performed on patients who have already a gastric surgery and suffer either from complications or have not lost weight as planned. These procedures are mainly performed laparoscopically, although open surgeries may be necessary if prior bariatric surgery left extensive scarring.
With the increasing number of bariatric surgeries performed annually, the number of patients who experienced unsatisfactory results. Moreover, there are a few weight loss options and some of them may limit further options for revision weight loss surgery.
Candidate for a Revision Bariatric Surgery – when the revision surgery is necessary?
If you are not satisfied with the results of your initial bariatric surgery or gained weight significantly, you probably would need revision surgery. You should be eager to follow the dietary protocol following the surgery. If not, revision surgery will be unsuccessful. It is vital to remember that losing weight starts from the surgery itself and it is continued till the rest of your life. The surgeon will examine you thoroughly and check your history prior to recommending the most suitable option for you. Also, he will determine which technique ( usually different from the previous one) will give the most desirable results
Reasons for revision gastric sleeve
Seven years after the surgery about 20% of gastric sleeve patients will be in need of a revision surgery. The most widespread reasons for gastric sleeve revision surgery are:
- insufficient weight loss
- weight regain called weight recidivism
- another side effects like gastric reflux ( yet is not common)
These mentioned above side effects can start from 18 months to 6 years after gastric sleeve surgery
Inadequate weight loss
Generally, patients after gastric sleeve lose weight as follow:
- after 3 months about ⅓ of excess weight
- after 6 months about half of the excess weight
- after a year up to 70% of excess weight
If you see that your weight loss is insufficient, contact your surgeon immediately.
Slow weight loss is mainly a result of imbalanced diet and poor lifestyle choices. Your surgeon will create an additional diet, lifestyle and provide support if needed. It is better to starts as quickly as possible incorporating these changes into your life so that you are likely to get back on losing weight. Although, insufficient weight loss is also caused by the surgeon who could perform the surgery improperly. The errors are :
- not identifying and fixing a hiatal hernia (a frequent issue connected with obesity)
- insufficient amount of upper stomach removal ( gastric fundus)
- insufficient amount of stomach removal
Gastric sleeve is mainly responsible for making a patient feel full sooner while eating through the reduction of hunger-causing hormones secreted by a stomach. These errors mentioned above may lessen or impede the effects of a bariatric surgery.
Generally, 3 out of 10 gastric sleeve patients may put on weight and the amount of regained kilograms varies ranging from a few kilograms to all of the weight. This issue may begin from 18 months to even 6 years after the surgery which is a result of:
- the number of hormones going back up ( for example ghrelin)
- insufficient number of postoperative support
- not following the recommended diet and lifestyle changes
- overeating with the result of a stretched stomach as a frequent reason for weight regain
The amount of weight regain varies from patient to patient, therefore one may put on weight slightly or significantly.
Persistent side effects
Revision surgery gastric sleeve in Poland may be necessary when revision gastric surgery side effects like acid reflux and hiatal hernia occur. Generally, about 2% of revisional surgeries are mainly caused by reflux symptoms that have not been treated by dietary changes or the application of medication.
Gastric sleeve revisional surgeries
Cheap Revision surgery gastric sleeve abroad is a type of bariatric surgery which may be performed to lose more weight in case gastric sleeve surgery did not work. There are three types: restrictive, malabsorptive or both. These surgeries carry complications, therefore, the throughout evaluation is vital to be done to make sure that you are healthy for the surgery. Some of them are done laparoscopically and others by open surgery.
Re-sleeve surgery resembles the original gastric sleeve surgery. It is resection of the dilated stomach which leaves a sleeve-shaped portion of the preferred size. The surgery is performed laparoscopically and is safe in comparison to other revision surgeries. A study revealed that a decrease in BMI from an average of 38.9kg/m2 to 32.2kg/m2 in those patients who had re-sleeved gastrectomy one year after the surgery. The average weight loss also increased from 25.3% to 56.3%. The complete resolution of sleeping problems and joint issues were proved and the considerable improvement was observed in those suffering from hypertension and diabetes by lowering their blood pressure and glycated haemoglobin ( HbA1c)
Safe revision surgery for gastric bypass
Another bariatric surgery which may be performed in case gastric sleeve fails is laparoscopic Roux-en-Y gastric bypass where there is a malabsorptive additional component to the restrictive mechanism. An upper pouch (50 ml) is made from the dilated stomach with the help of staples and it mainly works as the limiting component.
After that, the small intestine is divided at about 45cm from the stomach and the lower end of the divider is joined to the pouch during which upper end is connected to the small intestine 100 cm under the point of division. It considerably diminishes nutrient absorption
The anticipated weight loss is the same as primary gastric bypass surgery abroad. Although, the side effects like dumping syndrome, dehydration, gallstone formation are expected and should be treated immediately.
Duodenal switch (biliopancreatic diversion with duodenal switch) is a sophisticated and cost-effective bariatric surgery which may be performed as a primary procedure or as an alternative for a failed gastric sleeve. The components are both restrictive and malabsorptive, yet the restrictive element is a sleeve gastrectomy. Being a revise bariatric surgery, the stomach is resected ( a kind of re-sleeve) which is followed by intestinal refashioning. Here, the bile and pancreatic juice meet with the food at the very end of the small intestine. As the major part of the absorptive surface of the small intestine could be bypassed, barely a small amount of the nutrients may be absorbed. Also, the gallbladder is removed during the surgery which aids to avoid gallstone formation. In summary, affordable revision surgery gastric sleeve starts to be indispensable after gastric sleeve surgery after when a patient failed to lose weight or put on weight again. The most common options are re-sleeve, gastric bypass or duodenal switch. These types of surgeries also carry some complications, therefore, throughout examinations should be done prior to the surgery.
Mini Gastric Bypass- single anastomosis gastric bypass
The mini gastric bypass surgery is relatively a new procedure and supposedly the most suitable conversion for Gastric Sleeve patients as it is the least demanding to perform on and has high weight loss rate.
In order for the StomaphyX to be performed, a surgeon uses an endoscope which is inserted into your mouth, down into the stomach pouch. Due to the fact that it is performed through the mouth, incisions are not necessary. A surgeon suctions sections of the stomach tissue into a tiny opening in the StomaphyX device. This makes tissue folds that may be fixed together with the use of special H-shaped fasteners. Through the creation of a series of small folds, a surgeon shapes a small stomach pouch which resembles the one fashioned during the original gastric bypass procedure. The required number of folds is dependent on the stomach’s size. StomaphyX procedure is performed under general anaesthesia and it lasts about 30 minutes but the duration also depends on the size of the stomach pouch and the scope of the revision surgery. The main advantage of StomaphyX surgery is that your stomach is slower to empty and the feeling of fullness lasts longer.
Transoral ROSE ( Restorative Obesity Surgery)
The transoral ROSE technique is a relatively new technique similar to StomaphyX one where a surgeon put an operating system to an endoscope with four channels into the oesophagus down to the stomach. The transoral ROSE procedure is a weight loss surgery where there are no incisions made. A surgeon put instruments through the channels of the operating systems and stitches the link between the stomach pouch and the small intestine ( the stoma).
During the procedure, a surgeon uses stitches with tissue anchors to make a few folds in the place of stoma just to diminish its diameter. After that, sutures are placed with anchors in the stomach pouch. As a result, you feel full for a longer period of time which means you will lose weight quicker. In comparison to StomaphyX, the ROSE procedure puts sutures in a more precise way, may reduce the stoma, while StomaphyX is able only to diminish the volume of the stomach pouch. Initial results have indicated that the ROSE sutures persist longer than those in the StomaphyX procedure.
Transoral Outlet Reduction (TORe)
The transoral Outlet Reduction (TORe) is a type of procedure which is a good option after gastric bypass surgery when you put on weight and the main purpose of it is to diminish the size of the gastric pouch. After gastric bypass, it is possible for the gastric pouch to get bigger naturally which is a result of excessive eating. Through the use of the TORe technique it is possible to make enlarged gastric pouch smaller, therefore is proved it contributes to weight loss after weight regain. Moreover, it is reported that it is low-risk procedure resembling standard endoscopy. The procedure may take from 30 to 90 minutes and generally, a patient returns home the same day and may come back to work 3 days after
Shrink the soma by injecting a sclerosant (sclerotherapy)
It is the surgeon who decides if injecting a sclerosant (sodium morrhuate) into the stoma is the most appropriate option to resolve the issues with stoma dilation.
The injections, which are usually done during two or three procedures, leave scarring which reduces the stoma’s size.
According to one study, it is shown that almost 64% of patients lost about 75% of their weight regain after injections. The only side effect that occurred was symptoms of stomal stenosis.
In general, patients lost 10 pounds in six months but also there were cases where some patients lost 26 pounds. Also, those who experienced higher weight regain after the bariatric surgery responded well to sclerotherapy.
However, there are some side effects after the procedure which include:
- Transient, self-limited diastolic blood pressure elevation (11%)
- Bleeding ( 2.5% of patients)
- Small ulcers (1%)
- Abdominal pain ( 0.5%)
Those with cardiac risk factors should not consider this procedure due to possible risk of blood pressure elevation.
Addition of adjustable gastric band (lap band surgery)
The effects of inserting adjustable gastric band after failed gastric bypass procedure were determined by at least three studies
The first study was carried out on 11 patients who underwent gastric bypass surgery about 5,5 years earlier. There was a radical drop in their mean body mass index from 43.4 to 37.1.
The second study examined 22 patients who experienced weight loss of 47% after five years.
The thirst study was a compilation of seven studies which examined 94 patients who lost weight between 55.9% to 94.2% of excess weight between 12 to 42 months after the band placement. On average, one in five patients developed long-term complications which had to be followed with another surgery.
Lengthen the Roux limb
This type of surgery converts transforms Roux-en-Y gastric bypass into a distal Roux-en-Y gastric bypass. It is mainly taken into consideration when a patient suffers from a very low metabolic rate and experiences poor weight loss results even though exercise lot. Although this conversion would be a good option for weight loss, it may lead up to increased revision gastric surgery risks like a 15% leak rate after the revision surgery. Due to this, this type of procedure is not taken into account first for weight loss surgery and many surgeons believe that it is improper even for the failed gastric patients.
Lap Band revision surgery
Lap Band revision surgery is indispensable after fail weight loss or complications which need band removal generally performed as a single 2 step surgery which is band removal and a new procedure it has 4 options: rebanding, convert to gastric sleeve, convert to gastric bypass, or convert to duodenal switch. The most suitable method depends on the situation yet the great majority of surgeons advise on a single-stage procedure. Nevertheless, when your band is removed as a consequence of some complications, it may be a good option for you to let your body heal before another procedure. In such a case, two following procedures would be more suitable
The removal of the old band is replaced with a new one. According to some research, it occurs that results are corresponding to lap band surgery as a primary procedure and secondary (rebanding) one. When the primary gastric ban turned out to be a failure, the great majority of surgeons would not advise another gastric band.
Lap Band Revision Surgery to Gastric Sleeve
After a revision to gastric sleeve, the excess weight loss may be up to 60% in comparison to the pre-band removal weight. Complications following the procedure were said to be under 16% and there were no reported deaths.
Lap Band Revision Surgery to Roux-en-Y Gastric Bypass
Revision surgery gastric bypass abroad was advised more frequently than any other procedure. It was reported that revision gastric surgery success regarding weight loss after band removal was almost 70% of excess weight and regarding complications, the rate was from 9% to 17%
Dangers after revision surgery abroad
Almost one-third of patients who had revisional bariatric surgery performed at a single centre, experienced complications within three months.
Just over one quarter experienced complications 90 days after the revision. Nevertheless, it is stated that although revisional bariatric surgery is connected with the higher risk of preoperative complications in comparison to primary procedures, it is evident to be safe and effective if done in experienced centres.
Due to the widespread use of bariatric surgeries, revisions after complications or fail weight loss are more and more common. It is reported that revision bariatric surgeries range from 5% to 56% of all procedures. According to some researches, a great majority of those who had a revision surgery ( 69.6%) had experienced fail weight loss after the initial procedure. 26.8% of the patients suffered protein malnutrition. Those who had unsatisfactory weight loss, the vast majority ( 90%) of initial procedures were either vertical banded gastroplasty (stomach stapling) or gastric banding. Moreover, all of the patients with protein malnutrition had biliopancreatic diversion with Roux-en-Y gastric bypass. All of the procedures were open ones.
The most frequently performed revisions were conversion to a variant of biliopancreatic diversion with Roux-en-Y reconstruction (62.5%) and elongation of the common limb. Nevertheless, almost 40% experienced complications within 90 days and among them were an acute renal failure, anastomotic leaks, pneumonia, incisional dehiscence, bile leak or small-bowel obstruction. Another group ( 23.2%) experienced complications 90 days after the surgery which were stenosis of the gastrojejunal anastomosis, hypoalbuminemia, and incisional herniation. The largest group who had unsatisfactory weight loss experienced a decrease in the body mass index from a mean of 55.4kg/m2 to 35 kg/m2 after the revision. Those who underwent affordable revision surgery gastric bypass due to protein malnutrition, weight did not change dramatically after the revision surgery yet there was a total resolution of hypoalbuminemia without any complications.
Revision Gastric Surgery recovery time
The recovery period after any bariatric surgery is very fast. Generally, it is required to stay one night in the hospital and you can come back home the next day and even some patients are able to exercise the next day. It is obvious that there are some side effects like bruising or soreness yet all of them cede within a few days into little incisions applied to perform the surgery. Also, a surgeon may prescribe some painkillers so that you will recover with almost unnoticeable discomfort. As your body will not absorb all the food, a surgeon may prescribe also nutritional supplements just to keep good health. Moreover, some of them you will take till the rest of your life and among them are iron, calcium and many more. A dietical will also check if you comprehend everything properly and will provide you with all the necessary information
If you consider cheap revision surgery abroad, you should think about having weight loss surgery in Poland. Weight loss surgery in Poland cost half of the price in UK or Germany. Polish surgeons are highly experienced and our company cooperates with the best clinics of the biggest Polish cities. Experienced surgeons who deal with gastric procedures are known for high rate success, yet there may be a slight chance that you may not be fully satisfied with the results. Therefore, you should consider having revision gastric surgeries performed in Poland. As bariatric surgeries are gaining more popularity, more of the patients decide to have a revision due to unsuccessful weight loss. If you are not sure if you are a good candidate for this type of surgery, contact and learn more about the procedure. Among revision, gastric surgeries are re-sleeve, the laparoscopic Roux-en-Y gastric bypass, duodenal switch, mini gastric bypass and many more. Together with the significant loss after bariatric surgeries, a patient may also experience some complications, yet in general revision bariatric surgeries are safer and effective than primary ones. Also, recovery time is very short as some patients may come back to their daily routines even a day after the surgery.