subject: Revision Surgery- Is It Lifestyle Failure? [print this page] A single bariatric surgery procedure is usually sufficient for most patients, providing adequate long term weight loss. In some patients, the first weight loss surgery procedure may not result in the desired effects, and a second surgical procedure may be required. Which brings it to the inevitable question: Revision Surgery- Is it a Lifestyle Failure?
The answer is, not always: a repeat surgical procedure may be required to remedy insufficient weight loss, poor resolution of co-morbidities, and/or due to medical complications resulting from the weight loss surgery itself. The reasons for surgical failure must be thoroughly investigated, and other causes ruled out, before it is attributed to a failure to adapt to a healthier lifestyle.
This said, it must be mentioned that, of all the reasons to have revision bariatric surgery, inadequate weight loss and/or weight regain is the number one reason patients require a repeat surgical procedure. Very often, patients may not have been properly educated on how to make their bariatric surgery work best for them. Sometimes, the intake of the patient is not monitored by a dietitian, or the supervision of a physician maybe lacking or inadequate. The program of new eating habits to ensure that weight loss is safe and successful, together with a regular, simple exercise program and psychological support may not have been implemented.
A failure to create a better positive self-image and a whole new attitude to food can be an important reason for needing a repeat surgical procedure. Needless to say, ensuring proper education prior to bariatric surgery helps the patient achieve and maintain weight loss, while adequate long term care and support helps avert the need for a revision procedure.
Moreover, each patient is an individual whose body reacts to the surgery in a particular way, where one type of bariatric surgery meets the needs of a particular patient, the same surgery may not be sufficient for another. Quite frequently, the bariatric surgery metabolically and/or mechanically fails the patient as success after bariatric surgery involves more than just eating properly.
A patient's metabolism is an important determinant of loss of weight, as well as its maintenance. When patients require a repeat surgical procedure for metabolic reasons, it is labeled as a metabolic failure. This is a situation where a specific bariatric surgery does not address the metabolic needs of the particular patient. Correcting metabolic failure involves converting the patient to a bariatric surgery type that is more metabolically active. A patient, who has had a Gastric Bypass surgery with suboptimal results, might require a surgical procedure like Duodenal Switch, which is metabolically more active, instead of re-trimming of the pouch.
The consequence of reversal of the anatomical changes is a mechanical failure. This includes stretching and elongation of the pouch, enlargement of the diameter of the gastric pouch as well as increased absorption by the intestine. Rarer complications include formation of a gastro-gastric fistula and band slippage.
All of these eventualities will need a surgical revision in order to obtain and maintain the desired results in terms of both, weight loss and resolution of the co-mordities of obesity.
The common medical complications of weight loss include marginal ulcers, strictures, and severe dumping syndrome. These conditions may often be treated conservatively, but when conservative treatment fails, revision surgery is indicated.
Rarely, reversal of the surgical procedure may be necessary to treat cases of malnutrition, including issues of vitamin and mineral malabsorption, as well as severe dumping syndrome. Most nutrient imbalances and malabsorption syndromes can usually be managed medically by the use of dietary supplements. Rarely, surgical reversals for nutrient malabsorption may be necessary. The preferred course of action in these cases is a revision to a non-malabsorptive weight-loss procedure, allowing patients to avoid any weight re-gain.
Revision weight loss surgeries are generally riskier than the first time a weight loss surgery is performed. This is because revision weight loss surgical procedures generally require a longer time for the surgical procedure as well as recuperation. Open incisions are often required as the procedure is more complicated. There is greater blood loss, and the frequency of leaks and infections is known to be higher in repeat procedures. Also, predicting the impact of revision weight loss surgery on weight loss is less accurate. Most surgeons are of the view that weight loss after revision surgery is usually less than if the procedure was being done for the first time .
It is therefore imperative that the reason why the first surgery failed must be investigated thoroughly before the revision surgery is attributed to lifestyle failure alone. In fact each revision surgery is an occasion for the patient and the bariatric surgical team to introspect and determine the reasons for failure, so the same may be avoided for optimal results.
