Revision Surgeries at Barker Bariatric
At Barker Bariatric Center, we have performed hundreds of revision surgeries. Whether our patients have had a previous open abdominal surgery or not, we still perform all of our operations with a laparoscopic approach. Additionally, the vast majority of revision surgeries are performed as a one-step procedure. Only in special circumstances will a revision surgery need to be staged as a two-step procedure. We have not had an increase in complications after surgery by performing all of our revisions in a one-step procedure. The patients at Barker Bariatric Center can feel confident that they will receive a safe surgery with long term durable results.
The following are the types of revision surgeries that we routinely perform. Our surgeons are more than happy to discuss the best surgical option for you.
One of the most common revision surgeries that we perform is a removal of a band to another bariatric procedure. Typically, since a band is a purely restrictive surgery (meaning we are only affecting the size of the stomach), we recommend that most patients undergo a revision band to a gastric bypass. Studies have shown that this procedure will give the most lasting results. However, we do have patients that feel more comfortable with revision to a sleeve procedure. That too is an option, which we are more than happy to discuss with our patients at their initial consultation.
Laparoscopic Revision of Band to Laparoscopic Sleeve Gastrectomy
In a revision band to sleeve gastrectomy, we first remove the band and all the scar tissue surrounding the band. Often, a patient will have a hiatal hernia at the time of surgery and this too will be repaired to decrease the risk of GERD and pain. Once the band, port and scar tissue are all removed, we then proceed with the sleeve gastrectomy. We have found that patients are usually able to lose 60-65% of their excess body weight with a revision band to sleeve gastrectomy*. The complication rates are the same in our practice compared with a straightforward sleeve gastrectomy. Patients also have the same recovery time, about 1 to 3 weeks, for all of our cases at Barker Bariatric.
Laparoscopic Revision of Band to Laparoscopic Roux-en-Y Gastric Bypass
The gold standard for a revision band surgery is a revision of a band to a laparoscopic gastric bypass. Like other band revisions, a band to gastric bypass is performed in a single stage, only one operation. During the operation, we first remove the band, port and scar tissue, then we proceed with our gastric bypass. The risks for complications are the same as a gastric bypass performed in a patient who has never had surgery before and the recovery time, 1 to 3 weeks, is the same as well. A typical patient can lose 75% of their excess body weight, that is 75 lbs for every 100 lbs that they are overweight*.
Laparoscopic Revision of Band to Laparoscopic Duodenal Switch
When a patient presents to their initial consultation with a BMI over 50 and a previous band surgery, we generally recommend a revision of their band to a laparoscopic duodenal switch. Like a band to sleeve gastrectomy and a band to gastric bypass, we perform this as a single stage operation. We first remove the band, port, and any scar tissue. Then, we proceed with the duodenal switch. Like patients undergoing a duodenal switch who have never had bariatric surgery before, there is no increased risk for surgical complications and the recovery time is the same, 1 to 3 weeks. Generally, a patient undergoing a revision band to duodenal switch can lose the most weight, compared to the other two band revisions, about 85% of their excess body weight with little to no risk of weight regain*.
Revisions to Sleeve Gastrectomy
We are beginning to see more patients who desire revision to their sleeve gastrectomy as more and more patients undergo this particular surgery. The need for revision to a sleeve gastrectomy can be due to several reasons. If the sleeve was initially created too large, the patient will not have adequate restriction and therefore less weight loss. There are also patients who desire to simply have more weight loss, which a conversion to a bypass can provide. Also, there is a greater trend in patients undergoing sleeve gastrectomy who develop heartburn / GERD after surgery, even if they’ve never had symptoms before. If the reflux is so severe where medical management is not adequate, then the standard of care is to convert the sleeve to a gastric bypass in an effort to divert acid/bile flow away from the stomach.
In our practice at Barker Bariatric Center, patients have no increased surgical risk undergoing a revision sleeve to gastric bypass. Furthermore, recovery time is the same as well, 1 to 3 weeks. Typically a patient can lose 70-75% of their excess body weight*.
Revision of Sleeve Gastrectomy to Laparoscopic Duodenal Switch
When a patient is seeking a revision to their sleeve, we take into account the medical and surgical history of the patient. Generally, if a patient has a BMI greater than 50, then he or she is an excellent candidate for revision sleeve to duodenal switch. The sleeve is actually the first portion of the duodenal switch, however, many times the sleeve of our revision patients was made too large and it still needs to be revised for the best possible outcome of the newly created duodenal switch. We also have some patients who will present to clinic that may need to have a duodenal switch performed as a staged operation. This is rare, but when recommended by the surgeons it’s the safest option for our patients. In this case, the patient will undergo a sleeve gastrectomy. Then after a few months of weight loss, we are able to take the patient back to convert the sleeve to a duodenal switch.
Like all of our revision surgeries at Barker Bariatric, we have found no increase in complication rates or recovery time when compared to the original surgery. Typically, a patient can lose 85% of their excess body weight with little to no risk of weight regain once revised to a duodenal switch*.
Revision of Gastric Bypass to Super Malabsorpative Bypass / Duodenal Switch
The Gastric Bypass has been performed since the 1970’s. Over the last several decades it has undergone changes in how it is constructed, as well as transitioning from a procedure that was performed open to now almost uniformly performed laparoscopically. In our practice, we have performed many revisions to both open and laparoscopic gastric bypasses. Like all of our surgeries at Barker Bariatric, whether the original surgery was performed open or not, we will still proceed with a laparoscopic revision. There are basically two parts to the gastric bypass that is to be revised: the stomach pouch and small bowel rearrangement (which is the malabsorpative portion of the surgery). Prior to your revision, an EGD will be performed to size the stomach pouch. Ideally, we try to revise the stomach to a much smaller pouch in order to provide the patient with more feelings of restriction. In addition, we revise the small bowel rearrangement to be much more aggressive, based on the same construction of a duodenal switch.
Recovery time and risk for complications is the same as all of the other cases we perform. When a patient undergoes a revision to his or her gastric bypass, we usually see a 65-75% excess body weight loss*.
Revision to Vertical Banded Gastroplasty (VBG)
The vertical banded gastroplasty is a bariatric procedure that was popular in the 1990’s and is generally not performed anymore. However, we are now seeing quite a few patients requesting revision surgery since they typically did not offer patients lasting weight loss. Many patients we see have similar outcomes to laparoscopic band procedures – inadequate loss and/or weight regain of some if not all their weight. We base our revision procedure on the best research data, in terms to safety and efficacy (providing long term weight loss). In our practice at Barker Bariatric, we revise a VBG to a laparoscopic gastric bypass. Recovery time and risk for complications is the same as all of the other cases we perform. When a patient undergoes a revision VBG to gastric bypass, we usually see a 70-75% excess body weight loss*.
For more information about revision surgery, contact our Dallas/Ft. Worth bariatric surgery center today. Our staff will be happy to help you schedule a consultation.
To schedule a surgery consultation, contact our Dallas/Ft. Worth, Amarillo, Lubbock or Southlake practice today.