Plastic Surgeons in Beverly Hills - Los Angeles - Plastic Surgery

Revision Weight Loss Surgery

At Beverly Hills Physicians, we monitor post-surgical patients regularly to check for symptoms indicating a failed weight loss surgery. Symptoms of failed gastric banding that may require a new surgery include frequent vomiting after meals, low tolerance for solid foods, chronic reflux, ulcers, and chronic pain in the area just below the breastbone. Increased or increasing stomach pouch capacity in spite of repeated adjustments may also be a sign of a failed procedure. When the LAP-BAND® System or the REALIZE™ Band has failed, a switch from gastric banding to a gastric sleeve may be beneficial. Serving Los Angeles, Ventura County, Orange County, San Bernardino County and the surrounding areas, our surgeons are qualified to assist you in the failed weight loss surgery.

Why do some surgical weight loss procedures fail?

A surgical weight-loss procedure could fail for a number of reasons, including:

1. The patient regresses back to his/her “old habits,” and strays away from the recommended diet and exercise program
2. Mechanical complications following an appropriately constructed operation; for example, “pouch stretching,” “slipped bands,” and/or “fistulas.”
3. Failure happens due to the natural history of the procedure; for example, the vertical-banded gastroplasy or the jejunal-ileal bypass.

What are the symptoms of a failed bariatric procedure?

Below are the typical symptoms associated with four failed bariatric procedures. Keep in mind, not all patients have the same symptom. In all cases, be aware it’s normal to experience weight regain after initial success or a premature plateau in weight loss early after the procedure. If you think you may be experiencing a failed procedure, the first thing to do is to start a daily diary of your diet and exercise activity. Concurrently, contact your surgeon and nutritionist so they can rule out non-compliance; meaning that the procedure is failing because you’re not following your surgeon’s instructions, particularly on diet plan.

1. Failure after a vertical-banded gastroplasty
1. High frequency of vomiting shortly after meals
2. Decreased tolerance for solid foods (such as meats) and roughage (such as salad)
3. Chronic unremitting reflux
4. Non-healing ulcers found during an endoscopy
5. Chronic epigastric pain (pain just below the breast bone)
6. Increased capacity for food
2. Failure after a jejunal-ileal bypass
   In theory, regardless of the symptoms a patient may or may not have all jejunal-ileal bypasses should be reversed due to possible life-threatening liver failure. Individuals should always seek the guidance and services of an experienced bariatric surgeon to have this procedure done.
3. Failure after a laparoscopic adjustable band.
1. Increased capacity to food despite numerous band adjustments or fills
2. High frequency of vomiting shortly after meals
3. Decreased tolerance for solid foods (such as meats) and roughage (such as salad)
4. Chronic unremitting reflux
5. Non-healing ulcers found during an endoscopy
6. Chronic epigastric pain (pain just below the breast bone)
4. Failure after gastric bypass:
1. Development of frequent emesis
2. Increased capacity for food
3. Refractory strictures
4. Uncontrollable “dumping” of wastes
5. Pre-mature plateau in weight loss

The above list only represents the most frequently recognized symptoms; many others exist. That’s why it’s important for all patients to be followed closely by their primary bariatric surgeons. If such follow-up is not offered or no longer possible, it is imperative that the patients seek alternative surgeons. Patients suffering from symptoms similar to those listed above, or who have had a significant change in the way they feel, should request a thorough post-procedure examination and evaluation by their surgeons. A second opinion may be necessary if the primary surgeon’s level of expertise is not extensive. Also, patients should not hesitate to seek alternative opinions if it’s believed the symptoms were not thoroughly evaluated, or have somehow changed.

What is done during a weight loss surgery revision operation?

Unfortunately, there is no “standard of care” when it comes to fixing failed bariatric procedures. This is because most surgeons do not have extensive experience in revising bariatric procedures. That’s why it is imperative that a patient choose a revision surgeon even more carefully than the original surgeon.

During a revision, most experienced surgeons will take an evidence-based approach.

Surgical options for a revision include:

1. Vertical-banded gastroplasty.
1. Re-banding the gastroplasty
2. Re-doing the vertical staple line
3. Conversion to a gastric bypass
2. Jejunal-ileal bypass.
1. Restoration of normal anatomy
2. Conversion to a gastric bypass
3. Laparoscopic adjustable gastric band.
1. Re-banding
2. Conversion to a gastric bypass or gastric sleeve.
4. Gastric bypass.
1. Re-sizing the pouch
2. Re-creating the gastrojejunostomy
3. Lengthening the bypass
4. Banding over the bypass

As mentioned, there is no standard operation following a failed procedure. When taking an evidence-based approach, most surgeons agree that the gastric bypass is the best option following any failed procedure. They also agree that once a banding operation has failed (either a vertical banded gastroplasty or a laparoscopic adjustable band), the best surgical option is the gastric bypass. As far as the jejunal ileal bypass is concerned, the decision of restoration versus conversion to bypass is based on the patient’s desires and present weight.

What are the problems caused by failed weight-loss procedures?

When weight loss surgery procedures fail, they can result in significant metabolic and physiologic disturbances. They also can cause devastating psychological and emotional consequences, which often are the least recognized consequences following a failed operation.

Almost all patients who suffer from this problem have gone through the same cycle of emotions. After years of struggling with failed dieting attempts and severe obesity, they are accused of “taking the easy way out” by both family and friends alike when they seek surgical options. Then the initial success with surgery is received with mixed emotions by the same pessimists when the procedure begins to fail. The natural response is to blame the patient. The accusations start to fly, with some patients hearing degrading remarks such as “You couldn’t even do it with the surgery!” Unfortunately, these and other comments just add insult to injury. At this most fragile point in time, many surgeons also will place the blame or fault on the patient without an adequate evaluation. Sadly, in the majority of cases patients will not find assistance from their primary surgeon.

The typical search for a consulting surgeon to fix the failed weight loss surgery procedure can be heart-wrenching and seem endless since most surgeons aren’t willing to take on these types of problems. When another surgeon finally is found, typically a complete evaluation is offered. In many cases a mechanical issue with the gastric band maybe identified for the “failure” and a revision or correction is suggested.

Every patient considering a revision procedure needs to know it is not without some amount of risk, and requires more courage and support than the primary procedure itself. Even on the second attempt (which is medically indicated), most patients report little support is offered by family and friends. These emotional scars are very difficult to heal. However, when a weight loss surgery revision is performed by a surgeon experienced in such procedures a much higher chance for success is enjoyed. And as the pounds begin to go away, so too do many of the emotional scars.

Schedule a consultation or attend a weight loss seminar to learn more about which one is right for you.

Curious about adjustable gastric banding in Los Angeles? Contact Beverly Hills Physicians today. We have offices located all over Southern California, including Beverly Hills, Encino, Thousand Oaks, Valencia, Pasadena, Long Beach and Oxnard.