As per the name, redo bariatric surgeries, also known as revisional bariatric surgeries, are procedures performed on patients who have undergone bariatric surgery previously.
The reason could be weight regain, insufficient weight loss, and in rare cases complications from the previous bariatric procedure.
Understanding the Need for Redo Bariatric Surgery
These surgeries are technically more challenging and definitely demand a lot of experience and expertise from the surgeons. A thorough knowledge of the previous bariatric surgery that the patient has undergone is very important before embarking on a redo/revisional bariatric surgery.
Indications for Redo Bariatric Surgery
Inadequate Weight Loss
The patient didn’t achieve the expected amount of weight loss after the initial surgery.
Weight Regain
Significant weight regains after initially successful weight loss, which could be due to anatomical changes (e.g., enlargement of the gastric pouch or stoma) or lifestyle factors.
Complications from the Initial Surgery
- Severe Gastroesophageal Reflux Disease (GERD) after procedures like laparoscopic sleeve gastrectomy (LSG).
- Anastomotic Leaks
- Strictures or Obstructions: i.e. narrowing or blockages that cause difficulty in swallowing or food passage.
- Nutritional Deficiencies: after malabsorptive procedures like biliopancreatic diversion with duodenal switch (BPD-DS)
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Types of Redo Bariatric Surgeries
1.Revision of Sleeve Gastrectomy (LSG)
- To Roux-en-Y Gastric Bypass (RYGB): For patients with severe GERD or inadequate weight loss.
- Resleeve: Re-sleeving the stomach in cases where the sleeve has expanded, leading to weight regain.
- To Biliopancreatic Diversion with Duodenal Switch (BPD-DS): For enhanced weight loss and metabolic effects.
2.Revision of Roux-en-Y Gastric Bypass (RYGB)
- Distalization: Modifying the bypass to increase malabsorption for additional weight loss.
- Pouch or Stoma Reduction: Reducing the size of the gastric pouch or the stoma to address weight regain.
- Conversion to Biliopancreatic Diversion with Duodenal Switch (BPD-DS): In select cases where further weight loss is needed.
3.Revisions for Biliopancreatic Diversion with Duodenal Switch (BPD-DS)
- Lengthening of the Common Channel: To reduce malabsorption and address nutritional deficiencies.
- Conversion to Roux-en-Y Gastric Bypass (RYGB): In cases of severe nutritional complications.
4.Conversion of Adjustable Gastric Band (AGB)
- To Sleeve Gastrectomy: Removal of the band and conversion to LSG.
- To Roux-en-Y Gastric Bypass (RYGB): Band removal followed by RYGB, especially in cases of severe GERD or inadequate weight loss.
- To Biliopancreatic Diversion with Duodenal Switch (BPD-DS): In some cases, particularly in patients with significant obesity or metabolic disease
