RNY Gastric Bypass Surgery, or Roux-en-Y Gastric Bypass (RYGB), is the gold standard of bariatric surgery for managing obesity. Regaining weight following bariatric surgery is not uncommon. Patients with poor weight loss often feel angry or depressed. There are corrective procedure options that you can benefit from.

According to a study that appeared in Annals of Surgery in 2006, 35% of super obese patients and 20 percent of morbidly obese patients who had the gastric bypass gained back at least 50% of their weight after 10 years.[1]

Mexico Bariatric Center® provides a wide array of endoscopic and laparoscopic revisional weight loss surgery in Tijuana and Guadalajara, Mexico. Mexico Bariatric Center’s top bariatric surgeons have extensive experience in revising and reversing failed Roux-en-Y bypass surgeries.

Gastric Bypass Revision in Mexico

Surgery Duration:
2 – 3 Hours

Hospital Stay:
2-3 Nights

Hotel Stay:
1 Nights

Back to Work:
2 – 3 Weeks

Benefits of Revising a Gastric Bypass Surgery

Although gastric bypass is effective, a number of patients either fail to lose weight or develop complications. If you previously had gastric bypass and need a second surgery, Mexico Bariatric Center provides two options. The main changes that we do in gastric bypass correction surgery include;

Kimberly H - RNY Gastric Bypass Revision Surgery in Tijuana Mexico

“I highly recommend MBC, my whole experience, as well as my husband’s, was top notch.”

Julie

Gastric Bypass Revision Surgery

Causes of Gastric Bypass Failure

Revisional surgery is technically challenging, requires a longer hospital time, and is often linked with significant risks and diminished efficacy. You may be a candidate for RNY intervention if you have experienced and of the following problem post-operative.

1. Unsuccessful Weight Loss – The most common cause for lack of weight loss is not adhering to nutritional instructions. Ignoring dietary guidelines and consuming high caloric foods can impact the surgery’s success.

2. Weight Regain after Initial Weight Loss – Some patients initially lose weight for several months, but then regain the weight. Causes include changes in diet, dilatation of stomach pouch due to increased food consumption, or even genetics.

3. Botched Surgery – Complications after gastric bypass can happen. Post-operative problems include;

  • Surgical/Anatomical issues: gut anastomosis is narrowed, or stomach pouch is dilated
  • Medical issues: symptoms like diarrhea, ulcers, solid intolerance, dumping syndrome, anemia, severe constipation, severe gastroesophageal reflux disease, nausea, and vomiting

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When Revision Surgery is Necessary

Just because you have not been experiencing the expected results from your procedure, doesn’t necessarily mean you should get the revision procedure. Your doctor will first want to rule out other reasons for not losing weight or gaining some weight back, and determine if you are a good candidate for the Roux-en-Y gastric bypass re-operation.

Your Diet 

The first most obvious thing to rule out is your diet. Start keeping a food journal of what you have been eating, and be as honest as you can. Write down every bite of food, including drinks that you consume on any given day to help you and your doctor finds the right path. If your diet looks to be to blame, changing that first is going to avoid an expensive, and possibly unnecessary, procedure. Try out the 10-day pouch reset diet.

Exercise

After your gastric bypass procedure, diet and exercise are equally important. Cutting back on your food intake and eating healthier isn’t enough to lose excess weight and keep it off. Part of your post-surgery instruction is to get a moderate amount of activity as soon as your body has healed. Learn about exercise after bariatric surgery.

4 Gastric Bypass Revision Options

Gastric bypass re-intervention is performed if you have already had an unsuccessful or botched gastric bypass procedure. The RNY conversion is involved; a riskier procedure than the first surgery.

If the revisional operation is performed by an experienced and skilled surgeon in a dedicated bariatric surgery hospital, it carries less risk.

The type of modification is chosen depending upon the cause of adverse effects. The following procedures are effective for losing weight after undesirable outcomes:

1. Shrinking the Stoma

RNY gastric bypass stoma revision options - Mexico Bariatric Center

Reducing the pouch size can be performed in three different methods:

  1. The first option for gastric bypass revision surgery is to shrink the stoma by an injection called a sclerosant, in a procedure known as sclerotherapy. Sclerosant is made up of sodium correlate and is injected into the gastric pouch, which is the space between your stomach and small intestine. If the problem with your procedure were the dilation of your stoma, this injection could help. Usually, it requires 2-3 injections over a period of time. In the August 2007 issue of Gastrointestinal Endoscopy, there was a study performed on potential weight gain after bariatric procedures[2] It found that the average patient who got these injections lost at least ten more pounds in 6 months. There are minor complications possible, including abdominal pain, bleeding, and small ulcers.
  2. The second option is involved surgically correcting the diameter of the stoma, the restrictive part of the original gastric bypass. Small cuts are made through the skin in your belly to laparoscopically restore the size of the pouch to 1 cm. The operation is complex, not always successful, and requires a hospital stay.
  3. An enlarged GastroJejunal Anastomosis (GJA) can also be shrunk by endoscopic treatment. In this non-surgical procedure, the stoma gets retightened with a narrow tube going down the esophagus. If your doctor finds that the size of your pouch is too large, they may do so with either a StomaphyX, TORe, or ROSE approach.
    – StomaphyX is an endoscopic suturing system used to reduce the size of the dilated stomach pouch and stomach outlet.
    Transoral Outlet Reduction (TORe) endoscopy is a novel non-invasive revisional option to delay gastric pouch emptying. Full-thickness suturing to plicate the gastrojejunal anastomosis can be accompanied by argon plasma mucosal coagulation (APMC).
    Endoscopic Full-Thickness Suturing Plus Argon Plasma Mucosal Coagulation - Mexico Bariatric Center
    – The ROSE procedure, which stands for revision obesity surgery endoscopic, uses a simple method for narrowing your stoma.
    The cost for these endoscopic treatments is between $9,000 and $13,000 in the U.S.

2. Lap-Band

Incorporating the Lap-Band® into the Roux-en-Y gastric bypass is a revision alternative. Adjustable Gastric Banding (“Salvage Banding”) is useful in patients in which gastric pouch dilatation is the reason for gastric bypass failure.

In lap band surgery, a small adjustable silicone band is placed at the upper end of the stomach to reduce stomach size. This procedure is performed with laparoscopy by small incisions on the abdomen that heals quickly. If performed in a properly selected person, it results in excessive weight loss over months.

distal vs proximal RNY gastric bypass

Distal Vs Proximal Bypass

3. Lengthening the Roux limb

This process takes your original proximal Roux-en-Y gastric system and converts it to a Distal Roux-en-Y procedure, with a longer Roux limb. It is typically only done on patients that show a low BMR and lack of weight loss, regardless of their dieting and fitness regimen.

This procedure has the most risks, including a 15 percent chance of leaking, according to a study in the February 2008 issue of the Department of Surgery.[3]

4. Duodenal Switch Surgery

Duodenal Switch is an excellent revision bariatric surgery procedure for the majority of patients who have gastric bypass failure. In this procedure, a small banana-shaped stomach is created, and two parallel limbs of the small intestine are formed.

Food passes through a separate channel and juices of the liver and pancreas are drained through another channel. This procedure does not allow the mixing of food with digestive juices so, little absorption of ingested food and the patient loses weight quickly.

* Currently, Mexico Bariatric Center is not accepting patients for Gastric Bypass to Duodenal Switch Revision.

Starts at $6,995 $6,745*

RNY Reversal With or Without Gastric Sleeve

Reversing the RNY Bypass has become more popular with the advancement of laparoscopic bariatric surgery. The risk of the operation depends on the level of albumin in the blood and not the surgical approach.

How is Bypass reversal performed?

  1. Dismantling the duodenum from the gastric pouch
  2. Dismantling the jejunum from the lower part of the intestinal tract.
  3. The duodenum (roux limb) reconnects with the jejunum (biliopancreatic limb) like it was previous to the RNY procedure.
  4. The gastric pouch is to re-anastomosis to the gastric remnant to form the original stomach.

In RNY patients with malnutrition, it is necessary to prepare them with an intravenous ambulatory nutrition diet.

Why do patients get RNY Reversal?

  • Mal-Nutrition
  • Marginal ulcer
  • Hypoglycemia
  • Food intolerance
  • Short bowel syndrome following small bowel resection due to internal hernia
  • Persistent pain
  • Uncontrollable weight loss

Additionally, the sleeve gastrectomy can then be performed after the reversal of the gastric bypass.

Source: LAPAROSCOPIC REVERSAL OF GASTRIC BYPASS

Potential Tests Your Doctor May Require

After figuring out where you are with diet and exercise, your doctor will want to perform a few tests. These tests look for other potential causes of your lack of results, to finally figure out if the revision surgery is right for you.

Endoscopy: The endoscopy numbs you with medication, and then places a tube into your mouth and down your esophagus. It can look into your stomach to see the size of your stoma and pouch.

Upper GI: The upper gastrointestinal tract radiography (Upper GI) is a test that looks at your digestive tract in motion. You will first drink a colored dye and in the meantime, have x-rays done to see how you are digesting it.

Eating Test: Finally, there is the eating test. This test measures how much food you can eat before you start feeling full, and mainly shows if the gastric bypass was effective or not.

Gastric Bypass Case Studies

Here are two case studies performed by bariatric surgeons at Mexico Bariatric Surgery Center.

Case Study #1

Patient History

  • 56 years old patient with 54 BMI
  • Had RNY gastric bypass performed 32 years ago in the United States via open surgery
  • History of two more open surgeries for gallbladder removal and liver segmentectomy
  • Gastric bypass surgery was effective for four years until the patient began regaining weight more than she had prior to surgery

Conditions: Hypertension, Diabetes Mellitus, and Hypothyroidism under control.

Study Findings

We begin the surgery laparoscopic with simultaneous endoscopy. We found anastomoses in the gastric fundus 3cm under the Esophagogastric union with all integrity stomach and a Y Roux for bile drain.

The patient had a biliopancreatic length of 50cm and an alimentary length of 190cm. The length of the limbs was correct, but the patient never had the restriction component because the stomach is conserved. We dissect all scares and do a small gastric pouch reset to the standard limit (of 3oz approx).

Case Study #2

Patient History

  • The patient had gastric bypass in the United States
  • During surgery had to do open surgery
  • The patient developed a hernia along the incision
  • She had a hernia removed several times
  • She started gaining weight
  • Gastric bypass surgery was effective for but then the patient began regaining weight

Study Findings

The skilled bariatric surgeon, Dr. Jesus Ceja, did an endoscopy where he determined that the pouch appeared normal. They had to perform open surgery due to the prior procedure.

Dr. Ceja found the second anastomosis (Y Roux) was enlarged as much as 10 cm and had acted like a stomach. Doctors reduced the Y anastomosis to give the patient less absorption so she can lose weight. She is feeling great a day after surgery.

3 Comments

Tonia Nelson April 9, 2017, at 8:08 pm

Looking for someone to help with maybe a revision of my Gastric-By-Pass, that I had performed on me back in 2005.
I have also suffered from bi-lateral lymphedema in both legs… I have had the problem in my legs since the 1990’s. Please help me, someone.

Mexico Bariatric Center April 11, 2017, at 6:38 pm

Give us a call at 855-631-2413 if you’d like to see if we can help.

Evelyn Tolentino August 31, 2017, at 10:37 pm

Where can I get help because I had gastric bypass surgery in 2013 and have had a lot of complications diarrhea, constipation, vomiting, anemia, gain weight again and it has been too difficult to lose weight?