Revisional Bariatric Surgery 4.0

Performed due to complications or weight regain after surgery

The importance of revisional bariatric surgery to continue a healthy life

Bariatric Surgery has very good results in reducing weight and is an effective solution for the patient who has tried other forms of weight loss, but without success. However, even after the surgical procedure, the situation can become worrying again, with regaining of weight, deficiency of substances important for the organism or other complicating factors.

The need arises, then, for revisional bariatric surgery, whose main objective is to repair the problem that is contributing to the return of obesity to the patient and other ills related to health, diabetes or malnutrition.

Revisional gastroplasty is a method used to help those patients who had a problem after performing bariatric surgery, as a result below expectations and / or objectives or even a more serious complication. There are some situations in which the doctor who specializes in obesity may request a review.

However, these are specific cases and need to be analysed with the help of a multidisciplinary team, which will investigate what are the causes of the problem and the need to choose another surgical procedure.

In this way, the patient is subjected to a new surgical technique to improve his or her quality of life, repair any possible flaws that have occurred and, also, to reverse the clinical condition of a disease or health problem.

We now present the most used procedures in obesity revision surgery.

Its removal should occur in cases of dilation of the gastric pouch; in cases of esophageal dilation or in cases in which the gastric band has ceased to function, this is when the patient, despite having it well placed and functioning, begins to regain weight. Then the band is no longer doing anything and should be removed, but always with something in mind to do to the patient because if nothing is done, he will tend to gain weight. Thus, in a space between 3 months and a year, another bariatric procedure should be performed, such as bypass, sleeve or other.

As its name indicates, this is nothing more than performing a gastric bypass after surgery (or gastric band placement or gastric sleeve fail). If a revision gastric bypass is to be performed, it is, as the name implies, a restrictive gastric surgery.

When a revision gastric sleeve needs to be done, it should always be done after a surgery that failed, namely a gastric band surgery or a gastric sleeve surgery (when this fails to lose weight). Failure of a gastric sleeve is normally associated with dilation of the sleeve, and so correction is typically associated with a gastric resleeve or another surgery such as the duodenal switch or SADI.

The conversion of gastric sleeve into duodenal bypass switch is done whenever the sleeve fails to keep the weight stable, where the patient starts to increase in weight, and thus being enabling a gastric bypass or even a duodenal switch, or SADI, because the only thing that needs to be done is to section the duodenum and connect it to 2.5 meters from the distal intestine, thus increasing its malabsorption, without increasing the level of hypoproteinemia.

The placement of a ring in a gastric bypass can be done right in the first gastric bypass surgery, or when weight starts to increase, thus increasing the restriction, but care must always be taken as the placement of a ring increases by about 4% the risk of intragastric migration. Another of the surgeries that can be done is to transform the bypass into a Y bypass of the distal Roux, thus increasing malabsorption, but care must always be taken not to increase hypoproteinemia.

Distal Roux-en-Y Gastric Bypass

Transformation of the sleeve into a duodenal switch

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