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  • Roux en Y Gastric Bypass

    Do You Need A Revision Of Your Weight Loss Surgery?

    weight loss surgery revision

    Studies show that 15-35% of patients who undergo Roux-en-Y gastric bypass (RYGB) struggle with weight regain after surgery. Surgeons have offered revision for weight loss surgery to these patients as a way to encourage additional weight loss. However, no surgery is without risks nor complications.

    Is it okay to get weight loss surgery twice?

    In one study – completed in the Netherlands- physicians looked back on 47 patients who had unsuccessful long-term weight loss from their original RYGB. These patients underwent a second surgery to revise their original surgery.

    In this revisional weight loss surgery, their alimentary limb was surgically lengthened.

    Alimentary Limb

    The alimentary limb is a connecting piece of small intestine that empties the small stomach pouch to the very end of the small intestine.

    RYGB

    The purple arrows represent food traveling down the alimentary limb.

    As food travels down the esophagus, it empties into the small stomach pouch.

    From there, it continues through a connecting piece of small bowel before emptying into a “common channel” of small bowel.

    The food then enters the large intestine.

    Photo credit

    Outcomes from lengthening of the alimentary limb

    During a revision of RYGB weight loss surgery, the alimentary limb is reconnected at a lower point down the “track.”

    How much weight do you lose after gastric bypass revision?

    About 62% of the patients in this study who successfully completed the weight loss surgery revision had adequate weight loss. Their total weight loss improved from 12% to 30%.

    What is the success rate of gastric bypass revision?

    weight loss surgery revision

    Of the 47 patients in the study, 67% of those who had diabetes experienced remission. Roughly 50% of those with high blood pressure had remission as well.

    But not everyone had positive outcomes:

    • 1 patient passed away within 30 days of surgery likely due to an internal hernia
    • 11% of patients experienced protein malnutrition or horrible diarrhea (some were having diarrhea 7-20 x / day!).
      • Some experienced complete loss of control of their (liquid) bowel movements
    • Even though these patients were placed on maximal dosing of Bariatric multivitamins, 89% developed nutritional deficiencies.
      • The most common nutritional deficiencies were calcium, vitamin A, vitamin D, selenium, zinc, and protein (albumin < 32 g/L)
      • Some of these patients required intensive follow up, injections, admission to the hospital for tube feeding, and an additional surgery to correct the length of the alimentary limb again

    Bottom Line

    weight loss surgery revision

    This was a small study that looked at patients who had already undergone a weight loss surgery revision (retrospective study).

    If you’ve had Roux-en-Y gastric bypass and have been struggling to continue to lose weight after surgery, there are more surgical options available to you, as this study suggests.

    This specific type of revisional weight loss surgery has potential weight loss benefits including possible remission of diabetes and high blood pressure.

    Unfortunately, it does not come without the risk of nutritional deficiencies, significant diarrhea, and a decreased in quality of life.

    Other Solutions

    If you’ve been considering a second procedure for your Roux-en-Y gastric bypass, luckily there are other options worth exploring beforehand!

    As you are well aware, weight loss surgery (WLS) is a tool in your weight loss journey.

    The creation of healthy habits is one of the most important factors for losing (and safely maintaining) weight for the rest of your life.

    For the first year or two after surgery, you may have noticed your weight coming off relatively easily. This was because your body was adapting to having a smaller stomach and to the new detour system of your intestines.

    However, it is very common after the first few years of surgery for your weight to slowly creep back on.

    The majority of the time, this is due to old eating habits that have returned on a more regular basis.

    Regained weight can be discouraging, embarrassing, and frustrating.

    But it doesn’t have to be!

    If you’re looking for a way to kick-start your weight loss journey without going back under the knife, I can help!

    12 week weight management program

    Check out the 12 Week Weight Management Program to get your health back on track today!


    Reference:

    Weight loss and malnutrition after conversion of the primary Roux-en-Y gastric bypass to distal gastric bypass in patients with morbid obesity

    Author: Yonta van der Burgh,Abel Boerboom,Hans de Boer,Bart Witteman,Frits Berends,Eric Hazebroek

    Publication: Surgery for Obesity and Related Diseases

    Publisher: Elsevier

    Date: March 2020

    © 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

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