Institute
for
Laparoscopic Surgery Bellevue, WA
425-453-7888
425-453-7888
Revision of previous WLS
We see people in consultation who have had weight loss surgery elsewhere and aren’t happy with their results. Most bariatric surgeons don’t like to talk about their failures. We don’t see these patients as “failures”. We see them as people who need our help. We listen to their stories closely, order the appropriate X-ray studies, and carefully determine who will benefit from a second operation. Then we perform the right operation with a laparoscopic approach for the best result.
Although everyone’s case is individual, many of our revision patients fall into one of three categories:
- Previous stomach stapling many years ago, now with weight re-gain and/or symptoms of severe reflux or obstruction.
- Previous Adjustable Gastric Band with inadequate weight loss/weight regain or obstructive symptoms from a slipped or over-tightened band.
- Previous gastric bypass with inadequate weight loss or weight regain.
Is your pouch too large and why?
Some patients who are unhappy with their weight loss surgery results have a pouch that is "too large". These patients often describe being hungry much of the time and being able to eat larger amounts. They may have been told that they stretched out their pouch from overeating. We have found that a properly made pouch will rarely stretch too much and believe that most large pouches were made too large at the first operation.
If you feel that your pouch is too large, the first step no matter what bariatric operation you previously had (bypass, band, sleeve, stomach stapling...) is to evaluate the size of your pouch is an upper GI barium study followed by endoscopy. We recommend that the upper GI study be done by a radiologist experienced with weight loss surgery patients and endoscopy done by a bariatric surgeon.
OTHER CONDITIONS REQUIRING REVISION OF PREVIOUS WEIGHT LOSS SURGERY
Other conditions that may require a revision of your previous weight loss surgery include:
- intractable peptic ulcer disease
- stomach tumors requiring resection
- conversion of a malabsorptive procedure to LGB
- erosion of LAGB
Serving the Greater Seattle area including Bellevue, Kirkland, Redmond, Issaquah, and Renton. We currently see patients in Bellevue, Issaquah and Bellingham.
Appointments available soon in Kirkland.
Previous Stomach Stapling with Vertical Banded Gastroplasty:
Beginning in the 1980's, many weight loss surgeons offered an operation called vertical banded gastroplasty or VBG. Although there was often successful weight loss after this operation, VBG often resulted in staple line breakdown with weight regain or progressive scarring and narrowing at the banded stomach outlet with severe obstruction and heartburn. Due to the high incidence of these problems, most surgeons stopped doing this operation in the 1990's.
Although LAGB works very well for many people, there is a small percentage of patients who aren't very successful at weight loss with the band. For patients who have experienced limited control of their hunger and limited weight loss despite working with their band, we generally recommend band removal and conversion to gastric bypass. We are able to do this laparoscopically in over 90% of our patients.
Although most patients have sustained weight loss after gastric bypass, some patients lose less weight than they would like or start regaining their weight a few years later. Although food and lifestyle choices can affect long-term results after gastric bypass, there are three anatomic problems that may be associated with this situation:
Beginning in the 1980's, many weight loss surgeons offered an operation called vertical banded gastroplasty or VBG. Although there was often successful weight loss after this operation, VBG often resulted in staple line breakdown with weight regain or progressive scarring and narrowing at the banded stomach outlet with severe obstruction and heartburn. Due to the high incidence of these problems, most surgeons stopped doing this operation in the 1990's.
It is common to see patients who had a VBG more than a decade ago, now with weight regain and/or severe GERD. We generally recommend laparoscopic removal of the banded portion of the stomach with conversion to a laparoscopic gastric bypass.
Previous Laparoscopic Adjustable Gastric Band (LAGB) with too little weight loss or obstruction
Although LAGB works very well for many people, there is a small percentage of patients who aren't very successful at weight loss with the band. For patients who have experienced limited control of their hunger and limited weight loss despite working with their band, we generally recommend band removal and conversion to gastric bypass. We are able to do this laparoscopically in over 90% of our patients.
We also have seen patients who have lost weight after LAGB but are having difficulty with chronic band slippage, esophageal blockage and severe reflux. Although some of these patients can be helped by re-positioning and re-adjusting their bands, others are best off having band removal and conversion to either sleeve gastrectomy of gastric bypass. We have been able to do this laparoscopically in over 90% of our patients who needed surgery.
Previous gastric bypass with too little weight loss/regain
Although most patients have sustained weight loss after gastric bypass, some patients lose less weight than they would like or start regaining their weight a few years later. Although food and lifestyle choices can affect long-term results after gastric bypass, there are three anatomic problems that may be associated with this situation:
- a fistula between the stomach pouch and the separated stomach. This is generally because the stomach wasn't completely divided at the first operation but only partitioned off with transecting the stomach.
- a gastric pouch that is too large
- a gastrojejunostomy (the connection between the pouch and the small intestine RNY limb) that is too wide
In these cases depending on the individual anatomic problem, we recommend surgery with closure of the fistula with partial stomach resection, downsizing of the pouch, and revision of the gastrojejunostomy. We are able to perform these operations laparoscopically for the majority of our patients
