Unsuccessful bariatric surgery? Revisional surgery can help

This content is sponsored by MedStar Washington Hospital Center

Bariatric surgery can be a patient’s first step on the road toward a longer, healthier and happier life. However, there are times when a second procedure is needed to achieve the desired results.

Patients opt for revisional bariatric surgery when they have not achieved everything they needed from their first surgery, said Dr. Timothy Shope, chief of advanced laparoscopic and bariatric surgery at MedStar Washington Hospital Center. Patients can have varying results after their initial procedure. “Some of them do very well initially and then regain some weight, some of them fail to achieve substantial weight loss in the first place,” Dr. Shope said.

Patients may also seek revisional bariatric surgery if they experience problems related to their initial procedure such as bad reflux or long-term complications from gastric bypass like connection problems.

Revisional procedures can be performed as soon as a few years or as long as 20 years after a person’s first surgery. Most patients who visit MedStar Washington Hospital Center are in their 50s or 60s. Also, many of these patients have struggled with committing to healthier eating, exercising, or other necessary lifestyle changes before or after their initial surgery.

“Common things that we see are patients who had, for example, lap band surgery 10 years ago or so that did OK but ultimately they didn’t get what they really wanted or just want another option, another way to lose some more weight,” Dr. Shope said.

The technique used in revisional bariatric surgery depends greatly on how the previous procedure was performed. For example, if the patient had a gastric bypass versus a sleeve gastrectomy.

The risks associated with revisional bariatric surgery are essentially the same as the patient’s initial procedure, Dr. Shope said. Some risk factors may be amplified with revisional surgery. For example, staple line problems are more likely to happen in revisional surgery because doctors are operating on organs that were previously operated on, he added.

So when should a patient consider getting revisional bariatric surgery? Dr. Shope said patients need to have tried to work out any issues they are experiencing with weight loss and lifestyle changes.

“If it’s primarily about losing more weight, then they need to have [tried for] at least several years, and, in fact, insurance companies will probably halt approval based on the length of time they have given it a good effort,” he said.

After surgery, patients need to reapproach the process of weight loss and understand why they couldn’t lose weight in the first place – was it that the surgery wasn’t the best fit for them or that they weren’t ready for the needed lifestyle changes? Dr. Shope said patients need to be prepared and know how to aim for success the second time around.

“They really need to reframe their dietary intake, their exercise patterns and then use the surgery properly this time to help them get where they need to get to. That’s the biggest thing: this time around, let’s make sure that we do it right, that we have proper follow up,” Dr. Shope said.

There has been more of an emphasis placed on follow up visits after surgery over the last few decades, Dr. Shope said. Previously, the surgeon would see the patient once or twice postoperatively, then the patient was essentially on their own. Now, the medical team has more frequent and involved follow-up appointments that help set up a weight-loss and nutritional plan for the patient.

Patients who follow these plans diligently often see the most success, Dr. Shope said.

“They should follow the dietary progression afterwards and really make the changes that are necessary in their life not only from an intake standpoint, but also from a physical activity standpoint, like removing the stressors or triggers in their life that lead to food-seeking behavior and making sure that, if somebody else lives in the home with them, they aren’t bringing in tempting food. They really need to address a lot of spheres in their life to achieve the desired results” he said.

MedStar Washington Hospital Center offers a team of doctors who have extensive experience in revisional bariatric surgery. The advanced laparoscopic and bariatric surgery team has a certification through the American Society of Metabolic and Bariatric Surgery and its Metabolic and Bariatric Surgery Quality Assurance Program, which means the team excels and has the data and outcomes to support that, Dr. Shope said.

“Not a lot of places around here do revisional surgery because it’s technically difficult sometimes. It’s a little bit more risky for patients, so you have to be willing to not only accept that risk with the patient but be able to identify it, be able to mitigate it and minimize the problems that they can have with these things,” he said.

“It’s easy to do some of the straightforward cases — these more complex cases need to be at a place like ours where we’ve got a program, we’ve got the accreditation and certification to back it up and we’ve got the experience.”

For more insights from Dr. Shope, including a podcast, click here.

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