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
Reducing the pouch size can be performed in three different methods:
- 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 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.
- 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.
- 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).
– 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.
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 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.
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.