Gastric Bypass Revision & Reversal Surgery
RNY Gastric Bypass or Roux-en-Y Gastric Bypass procedure is among the most commonly performed bariatric operation for managing obesity. Most patients who undergo this procedure lose their excess weight within 12 to 18 months and come to a healthy weight by two years.
Although gastric bypass is well-tolerated and successful, a number of patients either fail to lose weight or develop complications. According to a study that appeared in Annals of Surgery in 2006, 35 percent of super obese patients and 20 percent of morbidly obese patients who got the gastric bypass procedure gained back at least 50 percent of their weight after the 10-year mark.
Mexico Bariatric Center® provides revisional weight loss surgery in Tijuana, Mexico. Mexico Bariatric Center’s top surgeons have extensive experience in revising and reversing failed Roux-en-Y bypass surgeries.
Causes of Gastric Bypass Failure
The failure to lose weight or getting difficulties after the procedure is called a botched gastric bypass. Here are the reasons you may need RNY revision;
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. Possible Complications – Complications after gastric bypass can happen. Post-operative problems include;
- Surgical or anatomical complications: gut anastomosis is narrowed, or stomach pouch is dilated
- Medical complications: symptoms like diarrhea, ulcers, solid intolerance, dumping syndrome, anemia, severe constipation, and severe gastroesophageal reflux disease, nausea, and vomiting
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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 more complex and as a result a riskier procedure than the primary bariatric surgery. However, 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 revision is chosen depending upon the cause of adverse effects. The following procedures are effective for losing weight after gastric bypass failure occurs:
1. Shrinking the Stoma
The first option for gastric bypass revision surgery is to shrink the stoma. This is done with an injection called sclerosant, in a procedure known as sclerotherapy. Sclerosant is made up of sodium correlate and is injected into the stoma, 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 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.
Incorporating the Lap-Band® to 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 an 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.
3. Reduce the Pouch Size
StomaphyX is an endoscopic suturing system used to reduce the size of the enlarged stomach pouch and stomach outlet (stoma).
If your doctor finds that the size of your pouch is too large, they may do so with either a ROSE or StomaphyX procedure. Both of these tighten your stomach with tubes going down the esophagus, so they are minimally invasive.
The ROSE procedure, which stands for revision obesity surgery endoscopic, uses a simple method for narrowing your stoma. It costs between $8,000 and $13,000. The StomaphyX is another option and works in a similar manner as the ROSE procedure. This is also $8,000 to $13,000.
4. 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.
5. 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 does offer Gastric Bypass to Duodenal Switch Revisional Surgery. Only a few bariatric centers in Mexico offer this complicated procedure.
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?
- Dismantling the duodenum from the gastric pouch
- Dismantling the jejunum from the lower part of the intestinal tract.
- The duodenum (roux limb) reconnects with the jejunum (biliopancreatic limb) like it was previous the RNY procedure.
- The gastric pouch is to reanastomosis to the gastric remnant to form the original stomach.
Why patients get RNY Reversal
- Marginal ulcer
- 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.
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 revision surgery. Here are the questions and tests your doctor may perform:
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.
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. Mexico Bariatric Center offers Nutrition Bootcamp to post-bariatric support group patients.
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
- 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.
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
- 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 patient began regaining weight
The bariatric surgeon, Dr. Rodriguez Lopez, did an endoscopy where he determined that the pouch appeared normal. They had to perform open surgery due to the prior procedure.
Dr. Lopez 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.