Laparoscopic Revisional
Weight Loss Surgery in Kansas City

Introduction to Revisional Weight Loss Surgery

Revisional weight loss surgery is a developing field in bariatrics.  Revision surgery offers a morbidly obese person a second chance at health and weight loss.  A previous weight loss operation can be fixed or changed to a different one, depending on what is the cause for the failure to lose weight.  In some cases the cause can be patient compliance, in other cases it can be staple line disruption, gastro-gastric fistula, pouch or pouch outlet stretching.  No revision operation is the same. The new revision operation can potentially be any of the standard weight loss operations, which will depend on patient choice, type of previous operation performed, findings during the pre-operative work-up and at the time of surgery.

The operation can be performed open or laparoscopically.  Our weight loss surgery program performs all bariatric surgery laparoscopically, even with previous open bariatric surgery operations.  At present it is the only program in Kansas and several states around the area performing revisional weight loss surgery.

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Am I a Candidate for a Revision Operation?

To be a candidate for any type of weight loss surgery, the individual must be morbidly obese.  Below are tools you can use to determine if you are morbidly obese and potentially a candidate for a revision of your old operation. If you determine you are morbidly obese you are a candidate for a revision.

Morbid obesity is usually defined as being 100 pounds over the ideal body weight. A better way of defining morbid obesity is by using the Body Mass Index (BMI). BMI is a calculated number that takes weight and height into consideration. A person weighing 300 pounds that is 5ft tall will have a higher BMI than a person weighing 300 pounds but is 6ft tall.  A BMI above 40 indicates that a person is severely obese and therefore a candidate for surgery. Surgery may also be an option for people with a BMI between 35 and 40 who already suffer from cardiopulmonary problems or diabetes.

You are likely morbidly obese if you:

• Are more than 100 lbs. over your ideal body weight, or have a Body Mass Index (BMI) of over 40
• Have a BMI 35 or greater and are experiencing severe negative health effects or co-morbidities, such as high blood pressure, diabetes, etc. related to being severely overweight
• Are unable to achieve a healthy body weight for a sustained period of time, even through medically supervised dieting
• Have physical, psychological, social, or economic problems that could be significantly improved by weight loss

Once you determine you meet BMI criteria, the next step will be to determine why your operation failed.  The two most common reasons the operation failed are for a technical reason (staples disrupted, stretching of pouch or outlet, etc.) or patient compliance.  It will be important to determine which before proceeding with a work up.

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Laparoscopic Revisional Weight Loss Surgery Procedures

The most important factor influencing what type of revision operation a person will undergo will depend on what operation the person had to begin with.  The surgeon will often request a copy of the operative report when available.  The operative report helps the surgeon know what anatomical changes were made to your stomach and potentially intestine to determine what surgical options are still available.  The usual next step is to undergo an UGI or Upper Endoscopy.  This allows the surgeon to see what changes time has brought to the anatomy described in the operative report.  Once this information is available the surgeon sits down with the patient to discuss which weight loss surgery operation or operations can be offered or how to revise the existing operation if a fixable problem is identified. 

A revision operation can potentially be any of the standard weight loss surgery operations offered: The Lap-Band, Gastric Bypass, Duodenal Switch, Biliopancreatic Diversion, or a Sleeve Gastrectomy.  Which operation is chosen will depend on patient choice, type of previous operation performed, findings during the pre-operative work-up and at the time of surgery.  

One important difference between revisional surgery and first time weight loss surgery is the operative risk, and operation effectiveness.  Revision surgery carries more risk because another operation is being performed in the same place that previous surgery was done.  Any time this occurs in surgery the operation carries more risk, mostly because of scar formation from the previous operation.  Operating in an abdomen like that is as if someone poured glue in it.  The surgeon has to slow down and separate intestine from intestine, liver from stomach, and etc.  The difficulty factor of the operation increases significantly.  The operation effectiveness may also differ.  Often the anatomy changes done at the first operation are not reversible, and the surgeon has to work with what is available.

For an example.  If a biliopancreatic diversion is being used as a revisional operation for a failed bypass operation. The revision BPD may not be as effective as a BPD operation being performed as the first weight loss operation.  In this example the existing bypass pouch has to be re-used as the pouch for the BPD operation.  The revision BPD is not able to take advantage of the restrictive component (new pouch) anymore, and is solely relying on malabsorption for weight loss. 

In addition, revision surgery is an evolving field.  Deciding which operation will work the best can be difficult.  The surgeon does the best he/she can with the altered anatomy by the previous operation.

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How Does Revisional Surgery Work?

Revisional operations work either by restriction, and/or malabsorption.  For details on how the Lap-Band, Gastric Bypass, Duodenal Switch, Biliopancreatic Diversion, or a Sleeve Gastrectomy will work as a revision operation, please access the appropriate link for each procedure. 

       

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Advantages of the Laparoscopic Revisional Weight Loss Surgery

The advantages and risks of revision surgery are similar to the specific weight loss operation used for the revision operation: Lap-Band, Gastric Bypass, Duodenal Switch, Biliopancreatic Diversion, or a Sleeve Gastrectomy.

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Risks of the Laparoscopic Revisional Weight Loss Surgery

Revision surgery carries additional operative risk to what is listed above:

• Longer operative time – due to scar from previous surgery
• Higher risk for bowel or organ injury – due to scar from previous surgery
• Higher risk for complications of all sorts – due to longer operative times, more difficult surgery from scarring
• Weight loss results may not be as high when modifying part of a pre-existing operation

It is very difficult to predict exact outcomes with revision surgery.  Every case is different, and each operation is different from another.  A more complete list of the potential risk and benefits of weight loss surgery operations is also provided for you by the Risks and Benefits link.

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Deciding on the Revision Surgery

The decision about which operation is best for you is a complicated and very personal decision. Although the information presented here may be helpful, you will be able to learn substantially more about the benefits and risks of the revision operation during your consultation with the bariatric surgeon or at our free weight loss surgery seminars.

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Weight Loss Surgery Program

Post-operative support can greatly help patients improve upon their weight loss success.  Our weight loss surgery program has a comprehensive post-operative support program.  We encourage patients to take advantage of the informational seminars, nutritional classes, behavior modification classes, and social support groups offered.  There is a lot of information we have introduced to you and want you to understand.  The support programs are designed to motivate you, as well as continue your education in the area of nutrition, behavior modification, and your weight loss operation.

Patients who have weight loss surgery must have lifelong medical follow-up.  Our surgeons want to meet with you on a regular basis, particularly during the first and second year when rapid weight loss occurs.  Your primary care doctor is also a very important extension of your post-operative care.  As you start losing weight your medical problems will start improving and you may not require the same dose of your medications.  Together we monitor and adjust your need for medication. 

The long term side effects of weight loss surgery can be subtle, and can appear months to years after the surgery. With the DS, diarrhea and foul smelling gas can be a problem, but they are usually just a minor nuisance that can be treated. Iron and Calcium absorption are also a concern with this operation, as with the Gastric Bypass. As mentioned above, nutritional and vitamin deficiencies are possible, but are successfully managed with supplements. Protein malnutrition is potentially a major problem, but it is rare with proper follow-up.

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The Next Step after the Laparoscopic Revisional
Weight Loss Surgery

Proceeding with weight loss surgery is a very personal and often difficult decision.  Educating yourself about weight loss surgery is a very important first step.  Although the information presented here may be very helpful, patients have repeatedly told us that attending the weight loss surgery informational seminars helped them the most.  At the seminar you will be able to separate fact from fiction, meet the surgeons, ask questions, and hear testimonials from patients who have already undergone weight loss surgery. The patient testimonials are often the highlight of the seminar.  Individuals considering weight loss surgery enjoy talking to patients and getting first hand accounts of how the operations have worked for them and how it has changed their lives. 

The next step is to meet in consultation with the surgeon.  The visit has multiple purposes:  determine your health and operative risk, discuss which operation may be best for you, answer your specific questions and concerns, and start the preparatory process toward getting insurance pre-approval and scheduling your surgery.  You can save about 45 minutes of your time at the doctor’s office by filling out the New Patient Forms prior to coming for your doctor consultation.

While waiting for your insurance approval, or obtaining your medical work-up start reading the Preparatory Guide and the Diet Guide for the operation you will undergo. These will prepare you for your surgery as well as what to expect after your operation.  For further questions do not hesitate to contact the office at (913) 322-7401.

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