Gastric Bypass Revision Surgery Options

1. Reduce pouch size: The first step to a gastric bypass revision is to reduce the small stomach pouch. Over time the pouch increases in size and becomes bigger. In those cases, we try to shrink your stomach pouch smaller which ultimately reduces stomach capacity for food intake.
2. Bypass more of the intestines: The second step is going into that bypassed portion. Normally we see six feet of intestines bypassed, or rerouted. If your previous bypass surgery was 10+ years ago, surgeons would only bypass 3 feet. This is referred to as a “short bypass”. We distalize that intestine to increase the length of the rerouted portion. So instead of having 3 or 4 feet of your intestines bypassed, we lengthen that portion and you will have about 6 to 8 feet. Distalize means to increase the length of rerouted intestines.

Endoscopic treatment can also shrink an enlarged GastroJejunal Anastomosis (GJA). In this non-surgical procedure, the stoma gets retightened with a narrow tube going down the esophagus. If your doctor finds that your pouch size 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).

Incorporating the Lap-Band® into the Roux-en-Y gastric bypass is a revision alternative. Adjustable Gastric Banding (“Salvage Banding”) is helpful in patients whose 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.

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 procedure’s problem was dilating your stoma, this injection could help.

Usually, it requires 2-3 injections over some time. In the August 2007 issue of Gastrointestinal Endoscopy, a study was performed on potential weight gain after bariatric procedures[2]. The average patient who got these injections lost at least ten more pounds in 6 months. Minor complications are possible, including abdominal pain, bleeding, and small ulcers.

This method surgically corrects the diameter of the stoma, which is the restrictive part of the original gastric bypass. Minor cuts are made through the skin in your belly to restore the pouch size to 1 cm laparoscopically. The operation is complex, not consistently successful, and requires a hospital stay.

Duodenal Switch is an excellent revision bariatric surgery procedure for most patients with 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.