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Revisional Bariatric Surgery 4.0
What is revisional bariatric surgery?
Revisional bariatric surgery is a procedure indicated for patients who have previously undergone bariatric surgery and who, over time, have failed to achieve the expected results or have developed complications related to the initial procedure.
It involves a surgical reassessment of the previous operation, with the aim of identifying the cause of failure and correcting it, allowing weight loss to be resumed and quality of life to be improved. In some cases, this approach may include revisional gastroplasty, when the revision involves correcting or adjusting the previously performed gastric procedure.
When may revisional surgery be necessary?
The need for revisional bariatric surgery may arise for several reasons, namely:
- Weight regain after an initial period of success;
- Insufficient results in relation to the expected goals;
- Dilation of the gastric pouch, sleeve, or oesophagus;
- Failure of the previously used surgical technique;
- Complications associated with bariatric surgery.
Each situation must be assessed on an individual basis, with the support of a multidisciplinary team that will evaluate the underlying causes of the problem and define the most appropriate therapeutic strategy.
Who is this surgery for?
Revisional bariatric surgery is intended for patients who require a new surgical approach after a previous bariatric procedure, with the aim of correcting issues that have compromised results or overall health.
The main objectives of revisional bariatric surgery include:
- Correcting anatomical or functional failures of the previous surgery;
- Treating complications associated with the initial procedure;
- Resuming weight loss in an effective and safe manner;
- Improving or controlling obesity-related conditions;
- Improving the patient’s quality of life.
The surgical technique is selected according to each patient’s clinical and surgical history.
Approaches in revisional bariatric surgery
In revisional bariatric surgery, there is no single technique suitable for all patients. Approaches vary according to the previously performed surgery, the results achieved, and the current clinical situation.
Surgical options can be organised into different types of revisional approaches.
Gastric Band Removal
Gastric band removal should be considered in cases of dilation of the gastric pouch, oesophageal dilation, failure of the band to function properly, or when the patient, despite the band being well positioned and functional, begins to experience weight regain.
In these situations, the band no longer fulfils its purpose and should be removed. However, it is essential to plan a new procedure, as if nothing is done, the patient will tend to gain weight.
Therefore, within a period of 3 months to 1 year, another bariatric procedure, such as gastric bypass, gastric sleeve, or another technique, should be performed, according to clinical assessment.
Revisional Gastric Sleeve
Revisional gastric sleeve surgery may be considered when a gastric band procedure has failed, or when there is dilation of the sleeve associated with reduced effectiveness in weight loss.
Depending on the case, a gastric resleeve may be performed, or conversion to another surgical technique may be considered.
Conversion of Gastric Sleeve to Bypass, Duodenal Switch or SADI
When the gastric sleeve is no longer able to maintain stable weight and further weight regain occurs, conversion to a technique with a greater metabolic component may be necessary, such as gastric bypass, duodenal switch, or SADI.
These options are indicated in selected cases and require strict clinical follow-up.
Conversion of Gastric Sleeve to Duodenal Switch
Conversion of the gastric sleeve to duodenal switch may be indicated in cases of sleeve failure, allowing greater effectiveness in weight loss through an increased metabolic component.
Revisional Gastric Bypass
Revisional gastric bypass is indicated when procedures such as gastric banding or gastric sleeve have failed to achieve their intended goals, or when there is a need to reinforce results.
It is a surgical procedure that combines gastric restriction with a more pronounced metabolic effect and is frequently used in the context of revisional surgery.
Placement of a Ring in Gastric Bypass
The placement of a ring in gastric bypass may be performed during the initial surgery, or in cases of weight regain after gastric bypass.
This technique increases gastric restriction but must be carefully evaluated due to the risk of intragastric migration of the ring.
Distal Roux-en-Y Gastric Bypass
Distal gastric bypass is an option used in specific situations, increasing the malabsorptive component to enhance weight loss.
This procedure requires strict clinical follow-up to prevent nutritional deficiencies.
Frequently Asked Questions
Is revisional bariatric surgery more complex than the first surgery?
Yes. Revisional bariatric surgery is technically more demanding, as it involves correcting or modifying a previous procedure, and should therefore be performed by an experienced surgical team.
Are the results immediate?
Results develop progressively and depend on the surgical technique used as well as adherence to medical follow-up.
Does everyone who regains weight need revisional surgery?
No. Weight regain should always be assessed to identify its cause. Not all cases require further surgery; the decision is made after a multidisciplinary clinical evaluation.
How long after the first surgery can revisional surgery be performed?
The time interval varies according to the clinical situation, the type of previous surgery, and the reason for revision. This decision is defined after specialised medical assessment.
Is revisional bariatric surgery always a completely new procedure?
Not necessarily. In some cases, a correction or adjustment of the previous procedure may be performed (revisional gastroplasty). In others, conversion to a different surgical technique may be indicated.
Can the patient choose the type of revisional surgery?
The choice of surgical technique is not made by the patient. It is determined based on clinical evaluation, surgical history, and the patient’s current health status.
Bariatric Surgery Specialist
Dr. José Pedro Pinto is a specialist in General Surgery with an Integrated Master’s Degree in Medicine from the Abel Salazar Institute of Biomedical Sciences at the University of Porto. After completing his specialist training in 2019, he worked for three years in the Head and Neck Surgery Unit. Since 2021, he has been a key member of the Obesity Surgical Treatment Unit (UTCO) at ULS Braga, a team that performs between 250 and 300 bariatric surgery procedures annually.
Dr. José Pedro Pinto has amassed over 10 years of surgical experience, particularly focusing on endocrine and cervical pathology, including thyroid, parathyroid, adrenal, salivary glands, and congenital neck lesions, as well as metabolic and bariatric surgery. From the early stages of his career, he developed advanced laparoscopic surgery skills, which he regularly employs in both elective and emergency surgical settings.
Additionally, Dr. José Pedro Pinto has a strong interest in trauma care. Since 2023, he has been an active member of the Via Verde de Trauma Working Group at Braga Hospital and serves as a senior instructor for International Trauma Life Support. He has pursued extensive training in trauma care, with a particular focus on Point of Care Ultrasound (POCUS). Dr Pinto is currently an instructor and coordinator for the advanced E-FAST course at PocusX.
He has authored and co-authored numerous scientific papers published in reputable journals and presented at national and international congresses and scientific meetings. Notably, in 2022, he received international recognition with a distinction from the International Federation for the Surgery of Obesity and Metabolic Disorders.
Dr. José Pedro Pinto is a member of several prestigious scientific societies, including the Sociedade Portuguesa de Cirurgia, Sociedade Portuguesa de Cirurgia da Obesidade e Doenças Metabólicas, European Society of Endocrine Surgeons, International Federation for the Surgery of Obesity and Metabolic Disorders, and the International Association of Surgeons, Gastroenterologists and Oncologists.
LOCATION
Where to get revisional bariatric surgery in Porto?
Schedule a revisional bariatric surgery consultation at Living Clinic, located at Av. da Boavista 117, 6th floor, Room 607, 4050-115 Porto.
Get all your questions answered by Dr. José Pedro Pinto.
