Revisional Bariatric Surgery

Revisional surgery is a second bariatric operation on someone who has already had one. Two situations lead to it. The first is weight regain or inadequate loss after a sleeve, a band or a bypass. The second is a complication of the first operation, most commonly severe acid reflux after a sleeve gastrectomy.

The commonest revision is converting a sleeve gastrectomy to a Roux-en-Y gastric bypass, which both restores weight loss and reliably settles reflux by diverting acid and bile away from the oesophagus. A stretched sleeve can instead be re-sleeved, a gastric band is removed and converted, and a bypass with a widened join can be revised or lengthened.

Before any of this, your surgeon looks for the reason the first operation stopped working. An endoscopy, a barium study and a full dietetic and psychological review come first, because regain driven by grazing and sweetened drinks will follow you through a second operation unchanged.

Assessment is more thorough than for a first operation and usually takes several weeks. You will have an endoscopy to look at the pouch, the join and the oesophagus, a contrast swallow to measure the anatomy, blood tests for deficiencies, and appointments with the dietitian and psychologist. A liver-shrinking liquid diet for two to three weeks beforehand is standard.

The operation is laparoscopic in most cases. Your surgeon first separates the adhesions from the previous surgery, which is the slow part and is the reason the operation typically takes two to three hours, longer than the original. The old anatomy is then taken down, the new pouch fashioned, and the joins made and leak-tested. Occasionally a planned laparoscopic case has to be converted to an open operation because the scarring makes safe dissection impossible.

You are helped up and walking the same evening. Fluids start once your surgeon is satisfied, often after a contrast study on the first day, and most people go home on the second or third day, sometimes later than they did after the first operation.

The staged diet is the same as after a primary bypass: clear fluids for a week, purees for two to three weeks, soft food for two more, and normal textures from around six to eight weeks, with protein first and no drinking during meals.

Plan on three to four weeks off work and six weeks before heavy lifting or the gym. Weight loss after a revision is real but usually smaller than after a first operation, in the region of 50 to 60 per cent of excess weight; where the revision was done for reflux, the reflux settles in the great majority within weeks. Lifelong supplements and annual blood tests apply as they do to any bypass, and the follow-up is closer in the first year. Regular contact with your dietitian over that year does more for the result than the choice of operation.