Weight Loss Revision

Bariatric surgery is successful tool for combating obesity and weight gain. However, some patients may need a secondary, or revisionary, procedure.

There are several reasons that a patient may need revision surgery:

• Inadequate weight loss.
• Weight regain.
• Persistent comorbid health conditions.
• Complications after weight loss surgery.

At Keyhole obesity surgery centre we specialise in revision weight loss surgeries, but there are increased risks associated with secondary surgery. So patients will need to carefully consider whether it is the right option for them.

Factors that may complicate revision surgery include:

1. Extended surgery.
2. Blood loss.
3. The need for open surgery, instead of the less invasive laparoscopic approach.
4. increased risk of infection and leaking.

The secondary procedure will depend on the specific needs and health problems of the patient.

Your doctor will discuss potential treatments with the patient and help them decide the surgical approach best suited to their circumstances.

Our weight loss centre has been established for more than 25 years, We have managed numerous patients who have had the gastric banding procedure. We are expert in revision gastric banding procedure. We have very low complication rates and good success following the conversion surgery.

We combine the resources of your surgeon, dietitian and psychologist to create a strategy that will give you a new beginning to your weight loss journey.

Please contact our centre for estimation of cost: (02) 9221 3919(02) 9221 3919.

Lap Band Revision Surgery: The options we offer.

There is currently no “gold standard” lap band revision since published research on the topic is limited. The option recommended by your surgeon will vary from patient to patient depending on reason for revision and your surgeon’s experience. In our practice and in Australia most common conversion is to sleeve gastrectomy followed by gastric bypass.

This page reviews everything you need to make the right decision…

• Which Type of Procedure is Best for You?
• One-Stage Vs. Two-Stage Procedure
• Cost, Insurance & Financing for Revision Surgery

Which Type of Lap Band Revision Surgery is Best for You?

There are two types of weight loss surgery procedures: restrictive (e.g., lap band, gastric sleeve) and malabsorptive (e.g. gastric bypass).

In our experience many lap band revision patients initially experienced excellent weight loss and health improvement following their lap band surgery. The most common reasons for gastric band revision was as a result of reflux symptoms, gastric pouch formation or slippage. In the past these patient would undergo repositioning of the gastric band as was able to improve their symptoms and regain controlled of their weight. Many patients states “I have had the band for many years and is very happy with it. If it wasn’t for the gastric band I would have developed lost control of my weight and have diabetes, Hypertension or a heart attack”.

This time I want to try the sleeve gastrectomy. For these patients, another restrictive procedure like gastric sleeve surgery may also be very effective.

Other lap band revision patients never really succeeded with their band. The reason being persistently vomiting or getting food caught above the band and too frequent adjustments. The weight loss or health improvement was minimal or did not meet expectations. For these patients, another restrictive procedure may not be the best option, and they may choose a malabsorptive procedure like gastric bypass.

One-Stage Vs. Two-Stage Gastric Band Revision Procedure

We surgeons recommend a two-stage procedure for sleeve and gastric bypass.

Under certain circumstances a single stage can be perform for conversion to gastric bypass.

Rebanding – One stage procedure, removing the old band and replacing it with a new one. Among the limited available research, it appears that results are similar for lap band surgery as a primary procedure and secondary (rebanding) procedure. If your initial gastric band was not successful, most surgeons would not recommend another band.

Adjustable Gastric Banding to Sleeve Gastrectomy conversion:

Not happy with your Lap-band or Realize Band? Haven’t lost enough weight? Tired of pain when you eat or food getting stuck?

Why choose to convert from an adjustable gastric band to the SG?

• Excellent results, >60 to 80% excess weight loss
• Much better sense of fullness (satiety) than in band patients due to reduction in the size and capacity of the stomach
• Superior appetite suppression due to the near elimination of the hunger hormone, Ghrelin.
• Minimally invasive approach
• Quick recovery – two nights stay in the hospital and back to work in 1 week
• No intestinal bypass or malabsorption, therefore little chance of vitamin or nutritional deficiency

What are the steps involved?

1. Conversion from Gastric Band to Vertical Sleeve usually requires 2 operations:
2. Low caloric diet for 2 weeks follow by removal of the band and unwrapping the stomach to its anatomical position.
3. Placement on low calorie diet 2-3 weeks prior to the next step
4. Performing Sleeve gastrectomy procedure after approximately 12 weeks following removal of your band which allows all inflammatory changes and scarring to settle making it much safer and successful procedure
5. Recovery plan following your VSG

Excess weight lost following revision to gastric sleeve surgery may be as high as 60% compared your pre-band removal weight. Risk of complications were most often reported as being under 16%, typically higher compared to primary sleeve gastrectomy.

Weight Gain after sleeve surgery.

IT is not uncommon for patient to regain weight after gastric sleeve surgery. It may be that the patient had gone back into their poor eating habits or getting for frequent meals.

The best options is either to convert to a mini-gastric bypasss or a Roux en Y gastric bypass.

You can make an appointment to discuss this options with our surgeon.

Post-Operative Care Post-operative procedures and instructions will vary depending on the surgery. Most patients will need to take time off work and prepare for several weeks of rest. Typically, patients should also expect to return to a post-gastric surgery diet of liquid and pureed foods.

Generally, weight loss will be less extensive after revision surgery, compared to primary surgical procedures.

Your doctor will discuss the specifics of postoperative care with every patient.

Lap Band Revision Surgery to to Roux-en-Y Gastric Bypass – Revision to gastric bypass was recommended more often than any other procedure among the available research. Reported weight loss since band removal was as high as 70% of excess weight, and complication rates ranged from 9% to 17%.

Cost, Insurance & Financing for Lap Band Revision Surgery

If you are insured your insurance plan will likely pay for the hospital cost of both the removal of your band and the revision to another procedure.

There is usually an out of pocket cost of $5000 to $7000 for conversion to sleeve or gastric bypass depending on the procedure taken.

For gastric band revision it typically cost $500 to $1000 depending on the degree of adhesions.

If you are paying for the procedure on your own, the additional cost could be up to $20000 for conversion of band to sleeve as a two stage procedure. Hence it would be more economical to join the health fund and wait for a year.

Single stage conversion is generally cheaper.