Revision Bariatric Surgery in Cancun, Mexico

Weight loss surgery can and does fail at times for a variety of reasons. Patients who experience failure many times are reluctant to seek assistance because they feel that every attempt they have made to reach a healthy stable weight, has failed so they themselves are a failure. NOT TRUE!

Statistically, 10 years post op 60% of all lapband patients no longer have their lapband. Lapband failure can be caused by:

• Erosion
• Slippage
• Pouch enlargement
• Poor access to adjustments
• A certain percentage of patients simply do not lose weight with lapbands.

Vertical Sleeve Gastrectomy failure can be caused by:

• Pouch enlargement
• Patient’s body adjusting to lower caloric intake

Gastric Bypass Failure can be caused by:

• Pouch enlargement
• Staple line disruption
• Stoma enlargement or failure
• Patient’s body adjusting to lowered caloric intake

These are not patient compliance issues – but mechanical failures.

The first step in revision surgery is to have an endoscopy and upper GI series not only to determine the cause of failure, but also for the surgeon to be able to visualize and plan precisely how he will execute the revisional surgery. If your insurance will cover these two diagnostic procedures, you may elect to have them done in the U.S.. If your insurance does not cover, you may want to fly into your surgical destination of choice at least a day prior to your revisional surgery to complete the diagnostics and discuss with your surgeon the options available to you.

Lapband patients will want to remove their lapband and revise to a sleeve gastrectomy or bypass. Some surgeons can or will revise a sleeve pouch, others will not revise the pouch but revise the sleeve surgery to a RNY (gastric bypass) or a DS (duodenal switch). Gastric bypass patients can sometimes have the staple lines repaired and the pouch trimmed. If the stoma has failed, the least risk approach would be to apply a lapband over the gastric bypass. The bypass may also be revised to a distal bypass and some surgeons will attempt to revise the stoma. A failed gastric bypass typically can’t be revised to a DS by most surgeons.

Patients of weight loss surgery must also factor in their personal genetics. Certain individuals are simply designed to store fat and several years after weight loss surgery, their bodies adapt to the malabsorption component and lowered caloric intake and patients begin to slowly gain weight again.

Patients considering revision must also be aware that revisional surgery has almost a 50% higher rate of complications than a first time surgery. Human tissue does form adhesions after the first surgery. Adhesions vary from person to person and have no bearing on the external scars on the skin. An example would be to picture 50 sheets of tissue paper in a stack, then pour a glass of water over the top and allow to dry. Each piece of paper is adhered to the one above and below, human tissue is similar in that a second surgery takes much more operating room time and skill because of the carefully dissection of layers of adhesions.

Risks common with revisional surgeries are leakage, necessity to revise a laparoscopic surgery to open surgery, incisional hernia (from open surgeries), bleeding etc. With all surgeries there is always risk with anesthesia, this can be minimized by using a surgical team with an anesthesiologist well versed in bariatrics.

Great strides have been made in the field of trans-oral surgery (surgery via an endoscopy procedure). While this field is still very experimental and in its infancy, this type of surgery may offer a low risk alternative in the future to repairs of enlarged stomas and other types of revisional repairs.