Revision Bariatric Surgery
Occasionally, patients who have had previous bariatric surgery will experience weight regain or develop a late complication which necessitates surgical revision of their original bariatric surgery.
Gastric Band Prolapse
Recent research indicates that within 10 years of having an adjustable gastric band, as many as 50% of patients will experience failure, defined by either a loss of less than 25% of their excess weight or the necessity of band removal due to a late complication, typically gastric prolapse (also known as band “slippage”).
Gastric band “slippage” is a misnomer. The band doesn’t actually slip into a different position, but rather, a portion of the stomach that was originally downstream from the band insinuates itself upward through the band, creating a large stomach pouch above the band. This larger pouch will hold more food, allowing increased calorie intake and possible weight regain. The larger pouch has more acid-producing cells than the normal small original pouch. Therefore, gastric prolapse is often accompanied by the new onset of GERD, or heartburn and/ or regurgitation. Finally, when the pouch enlarges significantly, it will cause improper orientation of the band leading to “kinking” and obstruction of the outlet of the stomach pouch with food intolerance and vomiting, requiring removal of the fluid from the band.
Gastric prolapse usually progresses over a long period of time and will not correct itself, even with band deflation. We do not recommend trying to surgically reposition the band or replace the band. The band should be removed, which is often accompanied by weight regain, necessitating revision to Sleeve Gastrectomy or Gastric Bypass at a later operation.
Phoenix Bariatric Center does perform Laparoscopic Gastric Band removal and revision to either Laparoscopic Gastric Bypass or Laparoscopic Sleeve Gastrectomy. We also perform revision of failed Sleeve Gastrectomy to Laparoscopic Gastric Bypass.
Weight Regain after Gastric Bypass and Sleeve Gastrectomy
Regaining weight after a Gastric Bypass is usually the result of resuming improper eating habits with increased calorie intake rather than a functional problem with the gastric bypass itself. Gastric pouch “stretching” is rare unless the original bariatric surgery was performed many years ago. At this point, it is unknown whether, over a long period of time, stretching of the Gastric Sleeve can occur. If stretching of the Gastric Sleeve can and does occur, it will permit the patient to eat more food (more calories) before a feeling of fullness is reached, causing the risk of regaining weight.