Laparoscopic Revisional/Redo Bariatric Surgery

Laparoscopic revisional surgery is when one bariatric procedure is converted to another procedure. For instance, a sleeve gastrectomy may be converted to a Roux- en y gastric bypass, mini gastric bypass or a SADI. Similarly, procedures like Roux-en y gastric bypass and mini gastric bypass may also be converted to other revisional procedures.

Laparoscopic revisional surgery is usually performed when:

  • The patient has not lost adequate amount of weight after the first bariatric surgery
  • The patient has regained significant amount of weight after the primary bariatric procedure.
  • There is inadequate remission of co-morbidities like type 2 diabetes, after the primary bariatric procedure.
  • There is re-emergence of co-morbidities especially type 2 diabetes, after a few years of the primary procedure.
  • There is a technical problem or a complication after the primary bariatric operation.
  • Patient is not able to cope up with the nutritional demands of the primary procedure.

Laparoscopic revisional surgery is more challenging and difficult as compared to primary bariatric surgery. Laparoscopic revisional surgery must be performed by surgeons with a good experience in primary bariatric surgeries as well as revisional bariatric surgery.

While performing laparoscopic revisional surgery, it is important to make a note of the following:

  • It is very important to understand the patient’s morale, psychology and behaviour. These patients have already undergone one bariatric procedure and have not achieved the desired results for a multitude of reasons.
  • It is essential to understand the cause of failure of primary procedure. This can happen due to multiple causes. These can be related to technical failures or issues with compliance after surgery. It is important to understand that obesity is a chronic progressive disease and sometimes a patient may need more than one procedure to achieve desired results. This is especially true for super-obese patients in whom a two stage procedure may be needed.
  • Choice of revisional bariatric surgery is very important. Before choosing a revisional procedures, factors like type of diet, family support, extent of behavioural and lifestyle modification etc must be taken into consideration.
  • Revisional bariatric surgery is technically more difficult to perform and the patients need to stay longer in the hospitals. There is also a higher chance of complications after revisional bariatric surgery as compared to primary bariatric surgery.
  • Revisional bariatric surgery is also more expensive than primary bariatric surgery.

Laparoscopic revision surgery after sleeve gastrectomy

Laparoscopic sleeve gastrectomy is one of the commonest bariatric procedures being performed world-wide. Off-late it is being seen that a significant percentage of patients are coming back with various degrees of acid reflux and weight regain. Laparoscopic revision surgery is indicated for patients who have persistent acid reflux despite long-term medical management. In such cases it is prudent to convert the sleeve gastrectomy to a laparoscopic Roux-en y gastric bypass to prevent further complications.

Sometimes, laparoscopic sleeve gastrectomy is performed as a first stage weight loss procedure in super-obese patients. These patients will need a laparoscopic revision surgery for further weight loss. In such cases a sleeve may be converted to a more mal-absorptive procedure to achieve further weight loss.

A sleeve gastrectomy can be converted to any other bariatric procedure. Re-sleeve gastrectomy, mini gastric bypass, Roux- en y gastric bypass, duodenal switch, sleeve with DJB and SADI are some of the options for revision after sleeve gastrectomy. The doctor and the team will discuss the best options with you based on your clinical profile.

Laparoscopic revision surgery cost after sleeve gastrectomy depends on multiple factors. Revisional bariatric surgery cost for conversion of sleeve gastrectomy to other procedures depends on the type of revision weight loss surgery performed. Laparoscopic revision surgery cost also depends on the duration of surgery and the difficulty level. Revision weight loss surgery cost may also depend on the type of equipment used during the surgery. The team will explain the cost in detail once a decision about the final procedure has been taken.

Gastric bypass revision surgery

After laparoscopic Roux-en y gastric bypass surgery, weight loss tends to plateau after 2 years. Some patients tend to regain weight over the next few years. This can happen due to various reasons. Some of these include, gradual dilatation of the gastro-jejunal anastomosis, enlargement of stomach pouch, poor lifestyle and eating habits, lack of physical exercise, non-compliance to the follow up protocol. Nowadays, a lot of surgeons prefer to apply an inflexible ring on the gastric pouch which prevents the anastomosis from dilating in future. This is called as banded Roux-en y gastric bypass and may help in limiting weight regain in future.

Gastric bypass revision surgery poses a challenge to the surgeon as it poses a more difficult challenge. It has been observed that the weight loss results after laparoscopic revision bariatric surgery are not as good as that after primary surgery. Therefore, laparoscopic revision bariatric surgery must be recommended to any patient after a lot of thought and deliberation. This is especially true for gastric bypass revision surgery. Unlike revision weight loss surgery after sleeve gastrectomy, options are more limited for gastric bypass revision surgery.

The options for gastric bypass revision surgery may include, pouch revision, endoscopic or laparoscopic revision of the gastro-jejunal anastomosis, application of a band over the pouch, conversion to a distal gastric bypass or conversion to a duodenal switch. Based on your clinical profile, our team of bariatric professionals will discuss the pros and cons of various options with you and advise the most suitable revision weight loss surgery procedure.

Cost of gastric bypass revision surgery depends on many factors such as the type of revision surgery chosen in a particular case. Gastric bypass revision surgery cost also depends on other factors such as duration of stay in the hospital, time taken in surgery, equipment used etc. Cost of laparoscopic revision surgery is usually higher as the grade of difficulty and time taken for surgery is usually longer than primary surgery.

Laparoscopic revision bariatric surgery after gastric banding

Gastric banding was very popular in the initial days when bariatric surgery first arrived in India. However, in a few years, a significant proportion of patients did not get the desired results. Some experienced weight regain and few had complications like band erosion and slippage. Gastric banding went out of favour within a few years and most patients with gastric bands got it converted to other bariatric procedures.

Laparoscopic revision bariatric surgery after gastric banding involves removal of gastric band and conversion to another bariatric procedure. Gastric band does not lead to any anatomical changes and hence can be converted to any other bariatric operation. Over the years, bands have been converted to sleeve gastrectomy, Rux-en y gastric bypass, mini gastric bypass, duodenal switch etc.

The type of revision weight loss surgery best suited for you will be discussed in detail by the team, basis your clinical profile. Sometimes, the revision may need to be performed in two stages. The first stage may include removal of the band and then three months later the revision weight loss surgery may be performed.

Cost of laparoscopic revisional surgery depends on multiple factors. Cost of revisional bariatric surgery for conversion of gastric band to other procedures depends on the type of revision bariatric procedure performed and whether it is done as a single stage or two stage procedure. Cost of revision weight loss surgery also depend on the time take for surgery and its level of difficulty and the type of equipment used in surgery.