Gastric Bypass Revision

Gastric bypass surgery patients generally seek revision weight loss surgery for two reasons:

  1. failure to lose adequate weight and/or weight regain
  2. medical complications (medical complications after gastric bypass may lead to failure).

Failure aftergastric bypass may be due to mechanical or metabolic reasons; the eating behaviors of a patient should be considered as well. In fact, the first step in assessing a patient who has failed to lose adequate weight aftergastric bypass, is to look carefully at the patient’s food consumption. When patients are not eating how they should, getting back on track is the next step.

There are a variety things that could happen next:

  • Some patients are able to return to the type of behavior they should be following, essentially getting back on track.
  • Some patients may not be successful at weight loss despite returning to proper dietary behaviors.
  • Other patients are never able to return to proper eating habits. This could mean a patient is non-compliant but not necessarily.

There are mechanical reasons that may cause patients to resort to maladaptive eating behaviors. A person’s character, for better or worse, does not necessarily contribute to this problem.

Gastric bypass may fail for the following mechanical reasons:

  • gastro-gastric fistula
  • pouch dilation
  • anastomotic dilation

Gastro-gastric fistula is where the stomach pouch grows back and re-connects to the bypassed stomach. This can occur as a consequence of a pouch leak, where the resulting local inflammation from the leak disrupts the staple line of the bypassed stomach where it lies next to the pouch. More often though, gastro-gastric fistula formation is a result of a less acute, slower process. Regardless the cause, gastro-gastric fistula allows food to pass from the pouch to the bypassed stomach, effectively partially reversing the gastric bypass. Revision surgery for this condition may consist of closure of the fistula, restoring the original surgical gastric bypass anatomy.

Pouch dilation is a condition where the stomach pouch stretches out and enlarges; anastomotic dilation is where the connection between the stomach pouch and the intestine stretches out. Both conditions result in allowing the patient to eat more than what would be required to remain successful. Re-trimming the pouch to make it small again is one approach to treating pouch dilation. Surgical banding and endoscopic fixation are two approaches to treat an enlarged anastomotic connection. These approaches to pouch and anastomotic dilation are both directed at restoring the anatomy of the gastric bypass procedure back to what it was prior to stretching out.

Depending on the reason for revisional weight loss surgery, other options may include: