Most of our patients approach bariatric surgery as a once-in-a-lifetime opportunity to regain control of their health and reduce their weight for good. In addition to writing this blog, I am also a Nurse Practitioner and a member of the clinical team at New You. But, I am also a bariatric patient myself. I had bariatric surgery in 2017, and I have experienced the process of preparing for surgery and practicing the healthy lifestyle habits as a permanent way of life. I was grateful that the process was fairly smooth and my weight loss results have been successful (lost 240 pounds!). However, there are some bariatric patients who require a second procedure to get the results they need to adequately manage their obesity. Obesity is a chronic disease just like any other disease and it may require multiple medical interventions for a successful outcome in the end.
“What is revisional bariatric surgery?”
It is an operation that is performed on a patient who has previously had bariatric surgery. The revisional bariatric surgery may be performed by the same surgical team as the primary surgery, but often the revision is completed by a different surgeon. Preparing for a revisional surgery is fairly similar to the process of the initial surgery, with the same dietary phases, pre-op testing, practicing new habits, etc. The main difference of course is that with revisional surgery, the patient has been through the process before, making it more familiar and less daunting than the first time.
“Why would a patient need a bariatric revision?”
There are multiple reasons why a patient would require a procedure to revise their previous bariatric surgery:
Staged procedure – There are situations where the surgeon decides ahead of time that the patient will have the bariatric procedure performed in stages, timed months to years apart. This decision is based on the severity of the obesity and/or the medical conditions that impact the patient’s ability to tolerate surgery, follow the lifestyle modifications, and recover from the anesthesia.
For instance, a patient with a weight over 600 pounds may not be medically stable enough to tolerate certain procedures due to complexity or duration of the procedure. In this instance, the surgeon would initially perform a less invasive, less risky procedure to affect some weight loss. Once the patient has lost enough weight to safely handle a more complex procedure, the second stage of the surgical intervention is then performed so that the patient’s weight loss momentum can continue. This does NOT mean necessarily that the patient has done anything wrong during the first procedure. It simply means that the severity of obesity requires this type of staged intervention to keep the patient safe throughout the weight loss process.
Weight regain – There are many reasons that a patient may regain weight. Since obesity is a chronic disease, lifelong management is necessary. However, unforeseen circumstances do arise that can impact the patient’s ability to sustain healthy habits that would lead to maximal weight loss. For instance, an unexpected pregnancy may inhibit weight loss progress. Other unforeseen factors include accidents, injuries, diseases, life or employment changes, divorce, grief, mental health changes, and financial stressors, to name a few.
New medical conditions develop – Even though most of our patients greatly improve their overall health after losing weight, there are some circumstances where complications develop over time. For instance, a patient may start to experience severe reflux or ulcers in the digestive tract that require additional surgery.
One of the most important lifestyle changes we require of our patients is smoking cessation, because smoking can very negatively impact the surgical outcome and overall health. The primary complication directly related to smoking is ulcers. This is an avoidable complication, so again we encourage our patients to be completely honest with their providers about any struggles you may be having, because we can help you!
The follow-up care after surgery cannot be emphasized enough, so even if you’re scared or embarrassed about something, we strongly recommend you talk with your provider about anything concerning you because your life and health depend on it.
Technical complications of the primary surgery – There are instances where complications may occur during or after an initial surgery that needs to be corrected or changed, making the revision necessary for the health of the patient and the success of the outcome.
“What types of revisional surgeries are there?”
Sleeve gastrectomy can be revised to a gastric bypass surgery, allowing the patient to lose more weight and in many cases resolve gastric reflux issues. Also, a sleeve gastrectomy can be converted to a SADI-S (Single Anastomosis Duodeno Ileal Bypass with Sleeve Gastrectomy). Additionally, some procedures can be modified with an over-stitch procedure which adjusts the internal anatomy to help with additional weight loss.
Each New You patient is thoroughly evaluated to determine the right procedure for their situation, so don’t hesitate to let our providers answer any questions you may have!
What are the typical outcomes expected from revisional surgery?
As with any bariatric surgery, the primary end goal is to attain a healthy weight. The revision outcomes will vary depending on the patient’s situation and which revision procedure is performed. The outcomes will include additional weight loss, losing any previous weight regain, resolving ulcers and/or reflux.
If the patient was not able to meet their weight goals from the primary surgery, there must be a thorough and honest evaluation of the patient’s readiness for a revision and their ability to sustain the healthy habits for life. Every effort will be made to address concerns and remove barriers the patient may have in order to achieve the most successful outcome possible.
In general, revisional surgeries statistically result in less weight loss than would be achieved with an initial surgery, but again, this can very by patient.
“Does New You offer revisional surgeries?”
Yes, New You does offer revisional bariatric surgery procedures, and we would be happy to have you consult with our surgical staff to determine the best course of action for your circumstances. If you have questions, don’t hesitate to call us for an appointment. We do accept patients who have previously received care from a different surgical office.
“Why is revisional surgery more expensive than initial procedures?”
The procedures are generally more expensive for several reasons. They are considered a slightly higher risk than primary bariatric surgery because they are generally more difficult, complicated, and longer in duration. The hospital fees for revisional surgery may be higher due to longer post-op hospital stay.
“If surgery failed the first time, wouldn’t it just fail again?”
This is an understandable concern, and facing a second bariatric surgery can be scary. Again, we must remember that obesity is very complicated so having some fear and anxiety is completely understandable. Here are some things to remember when considering a revision:
Be open and honest – Throughout the bariatric surgery process, it is extremely important that the patient be completely open and honest with their surgical team about lifestyle habits, medical problems, life stressors, mental health conditions, and other factors that may impact the outcome. By the same token, we at New You believe in complete transparency with our patients about expectations and possible complications, and we provide judgement-free care to each patient throughout their journey. Not all complications can be prevented, but we strongly encourage our patients to always approach any medical decision by reviewing all the information available.
Be realistic – The initial bariatric surgery has the greatest potential for weight loss, but, again, sometimes the post-operative period brings unexpected stressors and challenges. The weight loss potential from a second surgery is less because the metabolic processes are less reactive after the initial surgery. Make sure you have reasonable expectations if you are pursuing a revision surgery, and your New You team can give you some relevant statistics to consider about expected results.
Be committed: We are dedicated to our patients and have many systems in place to sustain long-term accountability, like regular follow up visits, even several years after surgery, support groups, both virtual and in-person, regular contact and resources to meet ongoing weight management needs.
If you have had weight loss surgery before, a revision is an option you may not have even been aware of. Many patients tell themselves that bariatric surgery is their “last resort,” but that simply isn’t true. Whenever you need help with whatever your challenges may be, New You will be here to help you meet them.