Revisional Surgery
For Failure To Achieve The Desired Weight Loss After Band,
Sleeve And Gastric Bypass Surgeries
BAND – OPTIONS
Conversion of gastric band to Sleeve Gastrectomy or Gastric Bypass used to have a lot of complications especially leaks from the staple line because of the scarring from the gastric band or ineffectiveness after a few years because of the stretching of the stomach where the scarring (capsule from the gastric band) was after a few years. This is resolved a large extent by excising most of the capsule of the stomach where the band was; this makes the stomach supple and expand well so that it could be divided with the stapler fairly safely at the operation itself. It is a technically demanding and time consuming operation and so one has to choose the right operation at the outset.
SLEEVE – OPTIONS
Sleeve could be converted to banded gastric bypass, OAGB/MGB or Duodenal Switch/SADI-S
GASTRIC BYPASS – OPTIONS
1. Converting gastric bypass to Banded Gastric Bypass – Applying fixed ‘ring’ to the gastric pouch with some reduction in the size of the gastric pouch and the Gastro-jejunal anastomosis. Primary banded gastric bypass (applying Ring at the index operation gastric bypass) gives very good results but secondary banded gastric bypass (applying Ring much later after gastric bypass) doesn’t give the same result; it could be that the patient find to get adjusted to the new restriction created by the ‘ring’. ‘Ring’ may have to removed for intolerance.
2. Just distalisation of the Biliary pancreatic limb (BP limb) by another 100-150cm: It does cause some amouth of weight loss but difficult to predict
3.Revise the whole gastric bypass and apply a minimizer ring to the gastric pouch with distalisation and repair the internal hernia if present with repair of HH and repair of any internal hernias. There will be some amount of weight reduction possible; better than the 1 or 2 alone.
4. Convert gastric bypass to Duodenal Switch/ SADIS (one cannot have SADI-S if one had GORD before one had gastric bypass) with repair of hiatus hernia. This is a more complex procedure but with almost guaranteed weight loss of about 30-40kg or more. The problems are: a) Stenosis/tightness can develop where stomach pouch is joined to remnant stomach to form the sleeve; this could result in inability to eat and the Gastro-gastric anastomosis may have to be stretched or revised. b) diarrhoea – 20-30 times going to toilet if one doesn’t follow the dietary guidelines of very low fat. c) nutritional deficiencies can occur unless one takes high protein (90-120gms rather than 60-90gms) in the diet and high doses of vitamins and minerals. Post surgery one has to be followed up thoroughly and should have blood tests every 6 months – FBC, LFT, vitamin D, B12, Folate, zinc, copper, selenium, magnesium and Ferritin.
websites of duodenal switch for information on DS :
https://asmbs.org/patients/bariatric-surgery-procedures#bpd,
https://www.dsfacts.com/index.php#,
http://duodenalswitch.com/moreinfo.html