Revisional weight loss surgery is becoming more and more common and necessary as the total number of weight loss operations increase each and every year. In the 1990's, there were less than 20,000 weight loss operations done yearly. Now, there are over 150,000 operations performed yearly.
Unfortunately, even though the knowledge of weight loss surgery has improved greatly over these last 10 years, there is still a significant number of patients who fail to maintain a satisfactory weight loss after these operations. Sometimes it is the patient's fault for not keeping with the appropriate post op diet and exercise program. Sometimes it is the fault of type of surgery performed, which does not allow the patient to lose enough weight. And sometimes it may be a little of both. In any event, there is in the best-case scenario a 10% failure rate and in the worst case scenario as much as a 40-50% failure rate. That leaves a lot of patients who had their first operation with the hope that this would cure their morbid obesity problems unsatisfied and in need of further surgery.
Over the years many different types of revisional surgery has been tried. Revising the size of the gastric bypass pouch or revising the size of the outflow of the gastric bypass pouch has usually resulted in a small additional weight loss but certainly not significant weight loss when the patient had remained morbidly obese after the first procedure.
Most of the successful operations for failed weight loss procedures usually involve creating a significant malabsorptive component to the already restrictive one, which was done initially. My colleagues Dr Sugarman and Dr Fobi have described various ways to do this and they have had more success than the above-mentioned revisions. Converting whatever operation, which was done initially to a duodenal switch is again the most challenging and difficult one to perform but it is the one, which gives the patient the best chance for success.
In my experience, two types of people present for revision. One group is those patients who did not lose very much weight at all long term from their first operation (i. e. - weight went from 300 pounds down to 200 pounds and rebounded up to 260 pounds). The second group is those who actually lost a significant amount of weight but were so large to start that they still remain morbidly obese (i. e. - weight went from 500 pounds down to 280 pounds and rebounded up to 330 pounds).
In both of these cases, converting a gastric bypass, or a laparoscopic adjustable gastric band, or a vertical banded gastroplasty to a duodenal switch will allow significant additional weight loss and allow these patients to maintain their final weight at a near normal level. It will also eliminate dumping syndrome and allow them to eat in a more normal manner. It is no doubt that this is my preferred operation to treat these unfortunate patients.
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