Revision (or corrective) weight loss surgery is a procedure to help correct problems associated with weight loss (bariatric) surgery.

The most common reason for revision weight loss surgery is not enough weight loss after the initial weight loss surgical procedure. While weight regain is the most common reason that people come to us for a revision of their weight loss surgery, there are many reasons why an operation may need to be revised. 

Revision surgery after weight loss surgery is what we call a second chance, and who doesn’t deserve a second chance? Each weight loss surgery patient is on an individual journey, and therefore, we do not utilize a “one solution for all” approach to weight loss surgery.

What if I fail after Weight Loss Surgery?
Most patients do not fail. As a matter of fact, most people do exceptionally well with their results post-surgery, and quite happy with their decision to undergo weight loss surgery.

Why Do People Sometimes Need A Revision?
(1)  Weight regain is the most common reason. There are some technical reasons that people regain weight, depending upon the operation. For the Lap-Band the device may fail. For the gastric bypass (RNY), there are sometimes changes in the anatomy.

(2)  The second most common reason for a revision is heartburn/reflux/GERD. Even if you have lost weight but suffer from reflux, it is best to fix that problem before the reflux becomes an issue with your health. This could be reflux of bile or acid.

(3) Inability to get enough vitamins, minerals, or nutrients from food from malabsorption: examples include iron, zinc, protein, thiamine (vitamin B1) or calcium.

(4) Scar tissue causing inability of food to pass through the guts – examples include bowel obstruction, pseudo-achalasia, stomach strictures.

(5) Ulcers, especially in the RNY bypass, which cause perforation, pain, bleeding, nausea, or vomiting.

(6) Ongoing issues with co-morbidities like diabetes, high blood pressure, lung issues. If you have not lost enough weight and there is a worsening of those co-morbidities of excess weight, then revision of the weight loss operation can help you to achieve your goals.

What Can I do to Prevent Needing another Weight Loss Surgery?
Use the opportunity to learn how to eat after your weight loss surgery. We provide simple-to-follow guidelines to help you eat properly in our Ventura weight loss surgery practice. We have discovered that when patients follow our 9 steps, they can lose more weight than average, and rarely gain the weight back.

However, even eating perfectly does not ensure that your body will be able to process the nutrients, vitamins, and minerals. It also does not guarantee weight loss.

Is there a surgery that will insure I will never need another weight loss operation?
There is never a guarantee, however the most effective long-term surgery for weight loss is the SADI/ duodenal switch operation.

What operation would you recommend for weight loss surgery?
The vertical sleeve gastrectomy is a great operation for most people. If the patient needs to be converted to a SADI or to a mini-gastric bypass (one anastomosis gastric bypass or OAGB), the sleeve is an excellent first step.  Historically, our patients rarely need another surgery, but there are instances that require a revision, and rarely does it have to do with weight loss.

Operations And Revisions
Lap-Band
Gastric Bypass
Gastric Sleeve

Lap-band revision is the most common surgical revision There have been thousands of Lap-Bands placed in Los Angeles and Ventura County over the last several years; unfortunately, many patients did not receive proper follow-up care. Some surgeons even elect to remove the lap-band completely when they discover them in a new patient.

Dr Simpson is an expert in the Lap-Band. Often a revision is as simple as removing fluid and rehabilitating the patient. If you are done with your Lap-Band journey, it does not mean that you failed weight loss surgery, it means that the band was not the right tool for you.

Sometimes we can remove the band and do a conversion to a gastric sleeve surgery at the same time. We recommend revision to a sleeve or to a mini-gastric bypass for patients who have had the Lap-band. After an evaluation, we can discuss your best alternatives.

Disadvantages and Complications of Lap-band Surgery It was marketed as being both minimally invasive and completely reversible. However, not all patients have good results from this procedure. Many studies have shown that more than half of the gastric bands are removed due to inadequate weight loss or complications after 7-10 years.

National Trend of Lap-band Surgery Lap-band once was the most popular bariatric procedure in United States (early 2010s). Many surgeons did not follow up with their patients, or patients simply didn’t achieve adequate weight loss, or they may have suffered complications.

Unfortunately, there were several fly-by-night commercial operations that promised getting thin with the placement of the lap-band but offered little or no follow up.

Due to the inadequate weight loss, weight regain, and high long-term complication rate, the use of the Lap-band has sharply decreased worldwide and in United States. Now, the Lap-band constitutes less than 5% of all bariatric procedures and the number of Lap-band procedures nationwide continues to go down every year. According to American Society of Metabolic and Surgery (ASMBS), about 35.4% of all bariatric procedures were Lap-band in 2011.

If you have previously had Lap-band surgery, our surgeons can easily evaluate your Lap-band, and can often make sure it continues to work for you.

Common Lap-band complications include:

• Food Intolerance: Patients may develop difficulty swallowing, severe nausea and vomiting. Some even throw up multiple times a day. This can be from the band being too tight, or the food too tough. Sometimes food that is healthy is hard to get down so patients end up eating soft food and gain weight. This needs to be evaluated. Dr. Simpson, Dr. Billy, or our nurses can adjust the band to see if this will help.
• Heartburn or Reflux: Some patients may develop heartburn or esophagitis after Lap-band surgery. This usually indicates the band is too tight or has an early slip. The band needs to have fluid removed and see how you do if this is the case.
• Band Slippage: This may cause severe pain/nausea and may require emergency surgical revision/removal of the gastric band.
• Excess Scar Tissue: Scar tissue may form around the band and this makes the band difficult to adjust. Patients find the band no longer works for them and when they try to adjust the band they go too tight or too lose. We cannot diagnose this without surgery, but we find most patients that have become intolerant to band adjustments have this. In this case, we remove the band and convert to another procedure. Sometimes, we must remove the band and let the stomach rest for a few months before revising.
• Band Erosion/Port Infection: This is a rare complication. Gastric Band erosion causes long-term port infection in most cases. If the band or port is infected, we need to remove the entire Lap-Band.
• Esophageal Dilation: Some patients may experience the esophagus becoming wider and dilating. This can cause an inability for the esophagus to do its job, which is to propel food into the stomach. This condition is called dysmotility or a lack of peristalsis. It can also lead to severe inflammation of the esophagus (esophagitis). In these cases, it can be as simple as removing fluid from the band and converting to a short-term liquid diet. It may also involve removing the Lap-Band.
• Inadequate Weight Loss: Even though the Gastric Band had reasonable initial weight loss, weight regain is much more common in Gastric Banding patients than patients who had gastric sleeve or gastric bypass surgery. For some, this is not the operation for them.

Some of the complications of the Lap-Band can be taken care of by adjusting the band, which is done in our office. Other times, the band needs to be removed and then the patient will undergo a revision to another procedure.

Lap-band Conversion to Sleeve Gastrectomy and Gastric Bypass  If you have an intolerance and/or complication to the gastric band, such as nausea, vomiting, dysphagia, slippage, or erosion, removal of your band offers immediate symptom relief. However, without converting to another bariatric procedure, many patients regain weight after Lap-band removal.

Our surgeons offer minimally invasive revision surgery to a gastric sleeve, SADI procedure, or bypass surgery, as early as three months after Lap-band removal surgery. In some patients, the revision happens at the same time as removal of the band.

The advantages of conversion to Gastric Sleeve (or Gastric Bypass) include:

• Better Quality of Life: Many patients discover they can enjoy a wider variety of foods than they could with the Lap-Band, like raw vegetables and chicken. Food doesn’t get stuck. The sleeve also allows patients to travel without the need for adjustments before and after travel.
• Significant Weight Loss Difference: In the long term, patients have much greater weight loss with gastric sleeve than with Lap-band.
• Second Chance: Sometimes people need a second chance. If the Lap-Band wasn’t the right tool, it served as a first step, and can lead to the right surgical revision. Success is within reach, and patients receive award-winning follow-up care by Dr. Simpson’s team.

Lap-band revision case study: Wendy underwent a lap-band and did quite well with it for several years, eventually she began gaining weight. She was unable to tolerate most vegetables, nor could she handle lean meats, like fish or chicken.

After an evaluation, it was clear a revision would be beneficial.  Wendy underwent a gastric sleeve operation and had her Lap-band removed. She says, “I can eat vegetables, and chicken, and I have lost even more weight – I love the sleeve.”

Gastric Bypass (RNY-gastric bypass) Revisions

What Works: Reversing the gastric bypass then converting to a sleeve with SADI (duodenal switch) works for people who need to lose more weight. We are the only center in California that does this.

What Does Not Work: Operations to make the stomach pouch smaller. This can be done endoscopically or laparoscopically,using a scope (through the mouth) to make the pouch smaller or to decrease the opening between the stomach and the small bowel. Changing the length of the small bowel often leads to increased diarrhea and malabsorption; additionally, evidence does not support patient success, utilizing this method. You’ll also have a challenge asking your insurance company to cover this procedure as they categorically do not.

Revision surgery of a gastric bypass is similar to having a house that needs repair. There is no one size fits all solution.  Doing the wrong repair could lead to increased complications.  Other issues requiring revision from the gastric bypass include severe heartburn/GERD/Reflux, ulcer formation, excess diarrhea, too much weight gain.

There is no one size fits all, for revision. It’s best to undergo a thorough evaluation of your anatomy and any health challenges, to determine the best course of action.

Our comprehensive evaluation includes endoscopic examination of the stomach, nutritional and diet assessment, and psychological assessment. This data allows us to determine the best course of action.

SADI case study:  Adriana had a gastric bypass over ten years ago. The last few years were a struggle as she regained all of her weight, weighing more than she did before her gastric bypass.

After a careful evaluation, we took down the gastric bypass and then converted her to a sleeve with SADI procedure. One year post revision, she weighs less and feels comfortable in her body again. Adriana loves her SADI/ duodenal switch.

Vertical Sleeve Gastric Sleeve Revisions This procedure is the most common weight loss operation in the world.

Weight Regain If the patient experiences weight gain, and a revision is needed, surgeons can revise to a SADI/duodenal switch or to a mini-gastric bypass (MGB) or one anastomosis gastric bypass (OAGB). Before a revision, your doctor will perform an evaluation including endoscopy, dietary history, and more.

Reflux/GERD/Heartburn One to 15 percent of people with the gastric sleeve will have persistent reflux that last one year or longer. It is common for the first year, however if it persists, an evaluation is necessary.

While many surgeons will convert the sleeve to a gastric bypass, this does not change the anatomy to prevent reflux.  If you have weight to lose and reflux then we would recommend conversion to a SADI or MGB.

Some insurance companies do not cover weight loss (bariatric) surgery. If yours does not, and you wish to have weight loss surgery, we offer the most competitive cash prices in the US. While we cannot compete with Mexico cash prices, we can offer your surgery in a Center of Excellence, complete with post operative follow up using video or phone and the knowledge that the people taking care of you meet the highest standards in the world. Interested – make an appointment today to talk to our Southern California office, convenient to Santa Barbara, Malibu, and Los Angeles, or email Dr. Simpson directly at terry@drsimpson.com.

If you are at a good weight, we can discuss a surgical anti-reflux procedure, such as the Linx device. The Linx device has revolutionized the treatment of Reflux, but it is not the solution for everyone.

Linx Device Case Study: Tracie had gastric sleeve and went from 200 pounds to 120 pounds. She suffered horrible reflux.  She had to sleep on a wedge pillow, otherwise she would develop a night cough and her asthma became worse. She was referred to our office after her dentist noticed her teeth were damaged from the stomach acid.

An endoscopic evaluation of her esophagus showed ulcers and changes called Barrett’s. We placed a LINX device to prevent reflux. Today, Tracie is off all heartburn medicine and examinations show a normal esophagus.

She didn’t need a bypass, her weight loss was great, and she doesn’t have that pain in her chest when she eats. Tracie can also sleep flat on her back without discomfort, and her teeth are no longer being damaged. Tracie was the right candidate for the Linx device. “I love this, I cannot thank you enough.”