Bariatric procedures are designed to promote rapid weight loss and relieve obesity-related comorbidities. By tampering with the stomach and anatomy, food intake is restricted while reducing caloric absorption. Most persons looking to undergo EndoSurgical procedures often ask this question: “is bariatric surgery reversible?” Patients generally seek reversal surgery due to:
- Medical complications
- Severe side effects
- Inadequate weight loss
- Malnutrition/Excessive weight loss
Only a handful of laparoscopic and endoscopic operations are truly reversible. In this article, we will identify the reversibility of bariatric procedures and outcomes that will likely transpire. We will also uncover all bariatric surgeries that can be fully or partially reversed.
Is Bariatric Surgery Reversible?
Yes, there are very few weight loss procedures that are reversible. Although many weight loss surgeons will not reverse a previous bariatric surgery unless there are traumatic side effects or severe complications.
How do we define “reversible?”
Reversible represents the ability to undo or revert a weight loss system to its original pre-surgery state.
In most cases, bariatric procedures that can be undone involve a foreign device inserted into the body to aid in restricting calorie intake. Some of these foreign bodies are designed to be removed at some point and can be extracted without any permanent changes to the body.
Reversible vs. Permanent Bariatric Procedures
Whether you get an endoscopic or a laparoscopic procedure, weight loss will be achieved by altering the stomach’s capacity (restrictive) and/or adjusting to the digestive tract by rerouting the intestines (malabsorptive). That is why most bariatric procedures, such as gastric sleeve and duodenal switch, are irreversible. If a procedure is not 100% reversible, returning it to its original state may cause complications.
| Bariatric Procedure | Methodology | Reversibility |
|---|---|---|
| 1. Gastric Band | Laparoscopic | 60% |
| 2. Gastric Balloon | Endoscopic | 100% |
| 3. Bariclip | Laparoscopic | 80% |
| 4. Endoscopic Sleeve Gastroplasty | Endoscopic | 70% |
| 5. Gastric Sleeve Plication | Laparoscopic | 80% |
| 6. RNY Gastric Bypass | Laparoscopic | 10% |
1. Gastric Band (LAP-BAND)
Description: Adjustable Gastric Banding is a restrictive method that puts an inflatable silicone ring planted laparoscopically over the stomach. Gastric banding aims to limit food intake, and it can be adjusted or removed at any time. Roughly 20% of excess weight loss is achieved after one year. A significant number of patients require lap band reversal due to experiencing food intolerance, slippage, erosion, port infection, and inadequate weight loss. The patient needs a conversion of their bands to sleeve gastrectomy or RNY bypass to keep the weight off.
Reversal Option: The band is retrieved by cutting through built-up scar tissue to expose the silicone device. The surgeon cuts the band from the stomach and carefully resects it from the abdominal cavity.
2. Intragastric Balloon
Description: The gastric balloon system is a temporary solution to jump-start weight loss. A balloon-like device inflated with gas or saline is inserted into the stomach endoscopically. Patients tend to feel a decreased stomach capacity/volume and unease when eating. The balloon comes in many different brands with an estimated weight loss of 15 to 25 lbs over a 6 to 12 months period. Individuals that experience serious discomfort, blockage, nausea, and vomiting are signs of a balloon intolerance and typically require reversal.
Reversal Option: First, the surgeon deflates the balloon endoscopically. At that point, it is extracted from the esophagus and out of the mouth. Gastric balloons are rarely preserved in the body longer because the risk of deterioration and gastric damage increases over time. The balloon can be extracted sooner if requested.
3. Bariclip
Description: The laparoscopic clip gastroplasty is a silicon-covered titanium clip placed over the stomach’s greater curvature. The procedure imitates the effect of a gastric sleeve by restricting food capacity in the stomach. Patients typically report an average of 20% excess weight loss in rather a short time. According to the founders of Bariclip, the procedure is alledged to be 100% reversible.
Reversal Option: Since no part of the anatomy is resected the procedure can be reversed. Bariclip can be removed laparoscopically before, if desired, or after reaching your weight loss goal.
4. Endoscopic Sleeve Gastroplasty
Description: Like gastric plication, ESG folds the stomach by cross-stitching sutures that are pulled like a drawstring to shrink the gastric capacity. Around 25% of total body weight loss is reduced after 12 months.
Reversal Option: To immediately undo this procedure, the surgeon will release the cross stitch sutures. If removed in a short time frame, the stomach can return to normal. In some cases, the stomach stabilizes into a sleeve form, causing the procedure to be permanent. It is reversible to a degree, but because of the nature of the procedure, a reversal may result in complications.
Patients not reaching ideal weight with Endo Sleeve can get a revision to a traditional VSG.
5. Gastric Sleeve Plication
Description: Gastric plication begins when the stomach is folded, or plicated, inward along the greater curvature. Staples are utilized to maintain and hold the fold. By reducing the stomach size to a “banana shape” similar to the gastric sleeve, weight loss will be accelerated. Usually, 15-20% of weight loss is reduced from the total starting body weight.
Reversal Option: By removing the sutures and staples the total plication reversal can return the stomach line to its original size. Long-term studies have controversial outcomes with this procedure as results vary from patient to patient.
Gastric Plication can be revised to a vertical sleeve gastrectomy.
6. RNY Gastric Bypass
Surgery Description: Gastric bypass, also known as Roux-en-Y (RNY), helps accelerate and maximize weight loss by combining malabsorption with restriction. Malabsoptrtion is created by bypassing the small intestines, resulting in significantly fewer nutrients being absorbed in the body, allowing food to pass without storing excess fat. The restriction is formed by creating the new “egg-sized” stomach pouch known as the stoma. Detaching the stomach from the stoma allows for fewer ghrelin hormones to be present, making the patient feel full much quicker.
Reversal Option: The reversal for RNY returns the intestines and stomach back to their original placement. Having reversion in the same area can lead to more complexities and risks of leaks, increased bleeding, infection, and scar tissue build-up. With such a demanding weight-loss operation, reversal surgery should be the last option if there are no other alternatives.
Reversing a permanent surgery, such as RNY gastric bypass, is complex and requires a super surgeon.
Is Bariatric Reversion Safe?
Almost all laparoscopic surgeries, such as gastric sleeve, are non-reversible. Reversible surgeries, like Lap-Band, are only in theory as they are considered impractical and often dangerous. Re-operation causes damage to the affected area and increases bleeding risks. Scar tissue can lead to longer operating times and more complex surgeries. Besides the associated dangers of reversing a bariatric surgery, you increase your likelihood of regaining back the weight or more.
Endoscopic procedures are primarily reversible; however, they are not as effective in losing extra weight and curing comorbidities. An intragastric balloon, for example, is a relatively safe and 100% reversible procedure, but only suitable for patients with lower BMIs who are disciplined.
Before undergoing any EndoBariatric surgery, make sure you consider all the pros and cons. Consult with highly qualified Mexico Bariatric Center’s surgical teams for the best option for you!
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