Revisional bariatric surgery is a procedure that a surgeon might perform to address a failed bariatric surgery. Also known as weight loss surgery (WLS), bariatric surgery modifies a patient's stomach and sometimes part of the intestinal tract to treat obesity that does not respond to more conservative treatments. The initial surgery might help the patient eat less and can change the way the patient metabolizes food to promote weight loss. Sometimes, it does not work or causes complications, and a revision is necessary.
Some patients do not lose weight after an initial bariatric surgery or lose some weight and rapidly hit a plateau. Others might develop complications such as metabolic problems or extreme discomfort while eating. Patients also might experience problems with comorbidities that existed before the original surgery. A doctor might decide that a patient is a candidate for revisional bariatric surgery if the surgery does not appear to meet expectations or if the patient expresses unhappiness.
One option is to reverse the surgery altogether. This might not always be available, because some surgeries are permanent in nature. Other theoretically reversible surgeries might cause severe scarring or other complications that make them difficult to reverse. Revisional bariatric surgery also can involve repairing a previous surgery or a transition to a different procedure when a patient does not respond to a more conservative treatment option. Before surgery, the doctor might request medical imaging studies to get a good picture of the inside of the patient's body, which can be useful for surgical planning.
Gastric bypass, gastric banding and bilopancreatic diversion are some examples of bariatric surgery. Before a patient goes into an initial surgery, the surgeon will have a consult to meet with the patient, discuss the goals of the surgery and decide on the most appropriate procedure for the patient's needs. The surgeon should also discuss risks and benefits; the need for revisional bariatric surgery to repair or revise a surgery is a potential risk.
If a patient requires revisional bariatric surgery, it might be possible to perform the procedure laparoscopically, through the use of small incisions on the abdomen. In other cases, the patient might have severe scarring or other complications that make it necessary to perform the procedure through an open incision. Going back to the surgical site can increase the risk of scarring and infection, and the patient might be at risk of adverse reactions to anesthesia. Patients who are in need of revision usually are thinner than at the previous surgery and might be less at risk of obesity-related surgical complications.