Revision Weight Loss Surgery in Lebanon

• The patient might not adapt the type of lifestyle required after that bariatric surgery.
• A specific bariatric surgery may not address the metabolic needs of that patient.
• The anatomical changes made to a patient’s body during surgery may not always maintained.

Firstly, it must be established whether it was the patient who failed the bariatric surgery, or the bariatric surgery that failed the patient. Patients may have not been properly educated about how to make their bariatric surgery work best. Proper education before a bariatric surgery will help a patient achieve and maintain the weight loss, an adequate long-term care may be all a patient needs to get “back on track.” After regaining weight, it may be extremely difficult for a patient to get back on the track, and to lose weight again.

Mechanical failures develop when the anatomical changes made during the original surgery are not preserved. Examples are as follows:

• The stomach pouch may stretch and become larger
• Outlet of a gastric pouch may dilate
• A gastro-gastric fistula may form and complicate the surgery. It may develop between the gastric pouch and the bypassed stomach
• The gut may increase its ability to absorb beyond the expectations
• A band slippage may result in a decreased restriction

Restoration of the original anatomy created in first bariatric surgery may work well for the above cases, restoring the environment that did allow for the weight loss initially. Re-trimming the dilated gastric bypass pouch or re-trimming the stretched-out vertical sleeve gastrectomy, are the options for treatment of the pouches that have stretched and enlarged. A dilated outlet requires a band placement around a dilated gastric bypass outlet. A deteriorated staple line of gastroplasty procedures can be re-stapled, but due to a high long term failure rate of gastroplasty surgeries, it is now recommended that gastroplasties be converted to a different type of bariatric surgery.

Weight loss after a bariatric surgery demands more than just eating properly. Metabolism of a patient does influence the weight loss or weight maintenance. When a patient fails after bariatric surgery for some metabolic reasons, it is known as “Metabolic Failure.” As the corrective procedures for mechanical failure of bariatric surgery tries to restore the previous anatomy, correcting the metabolic failure demands converting the patient to a type of bariatric surgery that is more metabolically active e.g. conversion of a Gastric Bypass into a Duodenal Switch in place of re-trimming the pouch.

Failure /incomplete resolution of co-morbidities after bariatric surgery is another reason a patient may consider a revision bariatric surgery. An unsatisfactory resolution of the co-morbidities is generally linked to the factors causing metabolic failure, as inadequate resolution of co-morbidities generally seen along with insufficient weight loss and co-morbidities are strongly associated with metabolism. Patients having unsatisfactory resolution of co-morbidities usually require a similar approach as for metabolic failure. This usually requires conversion of the failed bariatric surgical procedure, to a more metabolically active type of bariatric surgery.

After a bariatric surgery, some patients may develop medical complications that must be treated with a revision bariatric surgery. In few cases, treating the medical complications with a revision bariatric surgery will be very similar to the treatments previously discussed for mechanical and metabolic failure. However others may need reversal of the original bariatric surgery while weight loss is still preserved. Possible medical conditions which may require a revision include the following:

• ulcer
• stricture
• severe dumping
• malnutrition
• over-malabsorption
• metabolic bone disease
• iron deficiency/anemia
• vitamin deficiency
• vitamin-D deficiency
• thiamine (vitamin B-1) deficiency.