Revision Bariatric Surgery

At times patients may have either weight regain or reflux following laparoscopic gastric banding or laparoscopic sleeve gastrectomy and request further surgical intervention.

Following a laparoscopic gastric band patients will have the band completely removed and usually converted to a mini gastric bypass. This is still performed through the same five small incisions with an overnight stay. The surgery is more complex in view of the previous lap band however the risks are generally the same as for patients undergoing mini gastric bypass as a primary procedure. Statistically the rate of staple line leak may be in the order of 1%.

Following a sleeve gastrectomy, it is quite a straightforward procedure to convert to mini gastric bypass and still involves an overnight stay in hospital. Very often the diaphragmatic hiatus is tightened as well to reduce reflux symptoms.

Patients who have already lost significant weight from their original operation may not experience a similar weight reduction with the second procedure.


Mini Gastric Bypass

(Single Loop Gastric Bypass)

A gastric bypass is a surgical procedure to treat obesity that involves reducing the size of your stomach to facilitate early satiety and bypassing a section of your intestine to limit food absorption. As with the sleeve procedure, a reduction in size of the stomach restricts the amount of food intake and appetite.

BWLS mini gastric bypass

Procedure Mini gastric bypass, One anastomosis gastric bypass

This procedure was traditionally carried out by a Roux-Y procedure where stomach and intestine are reconnected in two places. A single anastomosis gastric bypass is a modification that simplifies this procedure, reducing operating time and complications both early and late.


EXPECTED WEIGHT LOSS: 30-50% total body weight loss

SURGICAL PROCEDURE:

Laparoscopic, 5 small incisions
Less than one hour

The gastric pouch is constructed similar to a sleeve gastrectomy but not as long. The small bowel is then measured 150-200cm downstream and joined to the end of the gastric pouch.

 

 

ADVANTAGES:

  • Laparoscopic procedure “keyhole surgery” so less invasive
  • Limits the amount of food ingested and also the calories absorbed
  • Increases intestinal production of GLP1 which stimulates insulin release and is more potent for diabetes cure
  • Ability to eat bread and meat is a little easier
  • A little more weight loss than sleeve
  • Potentially reversible

DISADVANTAGES:

  • Vitamin and trace element deficiency
  • Intolerance to certain foods
  • Dumping syndrome
  • Requires a lifelong multivitamin
  • Bile reflux, though rare

RECOMMENDED FOR PATIENTS WITH:

  • High BMI >45
  • Diabetics
  • Severe reflux
  • Prior gastric banding
  • Patient preference

RECOVERY:

After gastric bypass surgery:

  • you will stay in hospital for 1 night and have an x-ray in the morning (gastrograffin meal)
  • you will have pain relieving medications to keep you comfortable
  • you will be given instructions to follow regarding wound care, diet and activity
  • you will take Somac or Nexium for 3 months and then stop if reflux free

Patients should:

  • Keep the incision area clean and dry
  • Avoid strenuous exercises and lifting heavy weights for 2 weeks
  • Sip water throughout the day to prevent dehydration
  • Follow the diet regimen given to you by the dietitian
  • Follow a weight loss exercise program to maintain weight loss

POSSIBLE COMPLICATIONS:

  • Lifelong follow up with a physician is required for blood tests to ensure proper health and nutrition
  • Bowel leak through the anastomosis (surgical joins)
  • Gallstones
  • Dumping syndrome – meals flood the intestine causing dizziness, nausea and diarrhoea
  • Nausea
  • Dehydration
  • Indigestion
  • Reactive hypoglycaemia
  • Nutrient deficiencies
  • Incisional hernia
  • Wound infections
  • Marginal ulcers
  • Stomal stenosis
  • Haemorrhage
  • Infection
  • Bleeding
  • Bile reflux
  • Venous thromboembolism

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