Gastric bypass revision: Why and when to get one

Read more about our guide on gastric bypass

Chapter 8

Gastric bypass revision surgery is a second chance of fixing initial surgery complications whether surgical or weight-related problems. Revision surgery after gastric bypass is another operation either surgical or nonsurgical that helps you minimize the food quantity intake due to stomach enlarging but it could also be due to several symptoms.

If you want to undergo a revision, you need to be diagnosed by your doctor, and accordingly, that determines the type of operation needed and ensures safety. Gastric bypass revision is an option if the medication and a certain lifestyle was not a proper solution that does not help to develop your weight loss journey.

This chapter will cover information you need for revisional surgery and frequently asked questions.

Gastric bypass revision surgery: Definition and overview

Gastric bypass revision surgery is a treatment for those who went through either surgical complications, inadequate weight loss, or weight gain in their original surgery. Gastric bypass patients can modify and achieve their needed goals with better health through a bypass revision.

If you wish to undergo revision surgery, there are a few types that can be considered and your doctor will determine what is best for you. Each type is designed to solve a specific problem for instance:

Pouch resizing limits food intake and that action is taken if your stomach size got bigger.
Bypassed intestine lengthening which the intestines are reconnected to a further part of the smaller intestines. This helps the food to be digested even less with less nutrition and calorie consumption.
Conventional surgery: converting to another surgery is done depending on the circumstances that your doctor addresses relying on your case.

Revision surgery after gastric bypass is only considered if you faced tough challenges to reach long-term results. You also should do a consultation with your doctor to see if revisional surgery is recommended and understand the potential risks and benefits.

Why would you need a revision? 4 signs you may need to consider bypass revision

If you are facing difficulties or signs that get your attention from your original surgery, it is essential to check with your doctor to see what action should be taken. There are a variety of reasons that you might need to undergo a revision procedure such as:

Pouch dilation: pouch dilation can be caused due to pouch staplers or eating more than recommended, which leads to pouch size enlarging.
Gastroesophageal reflux disease: GERD sometimes occurs after gastric bypass and if it is not immediately fixed it will cause chronic acid reflux, heartburn, and pain in the chain. This could be because of surgical issues, that’s when a revision comes in to modify the problem.
Weight regain: If the initial procedure failed to serve your weight loss goals due to surgical problems, or choice of food, then you can consider an additional surgery if can’t be solved habitually.
Dumping syndrome: This causes sweating, diarrhea, and rapid changes in blood sugar. This can be solved by daily activities, meds, and changing diet choices. If the symptoms are too severe and chronic, then a revision might be necessary.

After careful consideration and examination, your doctor most probably will suggest a gastric revision surgery if non-surgical solutions were not helpful or wouldn’t help in the first place.

What is the truth about gastric bypass revision surgery's safety?

In terms of safety, yes it is a successful treatment although it has a potential risk of complications if the instructions post-op were left absent. The major complications are lessened if the revisional procedure was performed by a highly skilled bariatric surgeon.

That being said, bypass surgery has its pros and cons, but is it safe to have a gastric bypass revision? The recommended lifestyle guidance and constant dedication will make the pros overcome the cons. Keep in mind that the surgery is only to help you lose weight, so you need to coop with your body to reach your goals.

The benefits and drawbacks of getting a revision

Here is what you should know about bariatric revision benefits and drawbacks.

Benefits	Drawbacks
improve weight loss results	riskier than primary surgery
easy to target issues from primary surgery	not as effective as the primary procedure
long-term improvement	longer recovery time

Gastric bypass revision has no option of turning back or a third chance of enhancement, and it is a complex surgery that needs an experienced team. However, by following the instructions that are given by your doctor you can guarantee a higher chance of benefits and lowering the drawbacks or even turn them into positive outcomes and vice versa.

4 gastric bypass revision options

There are several options to undergo a revisional surgery if your initial weight loss attempt didn’t serve the desired needs or faced problems after months or a year of surgery.

Here is an endoscopic gastric bypass revision that requires:

Endoscopic suturing: This method serves lower food intake by suturing the inner side of the stomach. The goal is to minimize the stomach pouch digestion absorption to help lose more weight.
Endoscopic injection of botulinum toxin: This is a reversible option to help lose weight by injecting botulinum toxin. This helps the muscles around the stomach to relax, extend feeling full, and limit food intake.

These non-surgical gastric bypass revision options are known for their non-invasiveness and require less recovery time. However, it is also essential to discuss this with your doctor if it is a valid option relying on your case.

Surgical options that require surgical operation:

Gastric bypass revision to duodenal switch: This is still an experimental method to help patients revise gastric bypass. Not enough studies show duodenal switch conversion it’s safe because of its complexity and it also needs an experienced surgeon.
Sleeve gastrectomy after gastric bypass: In case of stomach pouch enlargening this approach is a fit option to fix the inadequate weight loss.

These surgical operations are major and very effective to become a healthier patient but it requires more recovery time and the qualification bar is higher than non-surgical types.

Well, what is the best revision surgery for gastric bypass? The answer depends on your overall health when your doctor examines you physically and mentally. Then the bariatric team will choose the best one that fits your situation by countering as many complications and serving the essential benefits for a better outcome.

Gastric bypass revision cost and expenses

Here is a table explaining the cost of gastric bypass revision in different regions around the world.

Country	Estimated cost range
Turkey	$6 – $10K
United States	$15K – $35K
Canada	$20 – $30K
United Kingdom	$10 – $20K
Thailand	$8 – $15K
Mexico	$7.5 – $12.5K
India	$5 – $9K

Side note: Medical touristic countries such as Turkey, Mexico, Thailand, offers all-inclusive packages. Other prices only include the surgery itself.

Gastric bypass revision surgery cost varies for many reasons such as country, type of conversion, type of facility, and reputation. Then comes the extra fees that add up to the cost, and they are post-op examination, anesthesia fees, facility fee, surgeon’s fee, and travel expenses in case you’re going to have plans to undergo surgery abroad.

You can know more specific numbers if you are qualified for surgery and ready to be undergone surgery such as, what actions will be done and the estimated overall cost. Furthermore, you can ask them if it can be covered by insurance.

Is gastric bypass revision covered by insurance?

Yes, it can be covered by health insurance, Bariatric surgeries in general are medical and essential surgery for obese patients. Gastric bypass revision is covered by insurance but you need assurance from the insurance provider. Check for the coverage percentage and its limitations. The higher quality of insurance the fewer limitations and the higher coverage.

Keep in mind that the request for insurance comes with a qualification standard. You can bring your documents related to surgery legibility and a report from your doctor explaining the medical necessity for the surgery. Only then your request can be accepted for insurance plans.

FAQ on gastric bypass revision surgery

Gastric revision after bypass surgery serves to fight morbid obesity and enhance the weight loss journey road to success. Here are the most asked questions answered for you that our patients wonder about:

How much weight can you lose with gastric bypass revision?

The average weight loss after gastric bypass revision is 10-20%. You should know that revision surgery does not serve as much weight loss percentage as primary surgery. Remember, the surgery is to helping hand for you to lose weight.

You need to follow the pre and post-op guidance that is given to you by your doctor to be able to reach the weight target that was not achieved in the first place due to difficulties and challenges.

When can you get a bypass revision?

Periodically, you can get a bypass revision at least a year and a half later from the initial surgery. The reasons must be identified and addressed by your doctor then determine the type of surgery.

The most common reason for a second surgery after bypass surgery is mainly because of weight regain or insufficient weight loss. There are other less common reasons as well such as surgical complications that may have caused hernia, bowel obstruction, or gastroesophageal reflux disease (GERD).

Sometimes there are solutions to be considered that do not require additional surgery such as malnutrition, anemia, or vitamin deficiencies but in case of medications, or supplements were not helpful then a revision surgery becomes a valid option to be considered.

However, the decision ends up in your doctor’s hands to help you overcome the problem you might be facing.

Can you reverse a bypass revision?

Yes, reversing a bypass is possible, but this thought cannot be taken lightly due to the surgery’s complexity from many angles. The revision is already a major surgery, reversing it isn’t the opposite and isn’t taken lightly.

After all, you need to talk to an expert to determine if it’s a possible case for you, it is not an easy decision due to its health risks.

Does the recovery last longer?

Generally, it does last longer to recover compared to the first surgery. The reasons may be to balance your health status, surgery invasiveness, and medications as well. However, if the operation was done endoscopically, it might require less hospital stay. Non-surgical approaches are not invasive compared to the surgical approach for revision surgery.

Do I need to do a post-op diet after revision?

Most definitely you do need a post-op diet after a revision as you needed in the first surgery. The diet starts with liquids and to more solid food over time. The scale of the food chain differs from one type of surgery to another and serves what your body needs to stay healthy.

However, the purpose is to help the surgical area to heal during recovery time and then proceed to achieve your desired weight loss goals over time.

How many times can I get a bypass revision?

Statistically, you only need to undergo a revision once to fix and serve the purpose of the initial surgery. However, it is possible to undergo a revision more than once but the risks will be greater than the first, and second surgery.

The ultimate decision will lay in your doctor’s hands if it makes logical sense and manages to have positive outcomes without harming your organs.

References:

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Moon C, Ghiassi S, Higa K. Laparoscopic revision of distal Roux-en-Y gastric bypass to duodenal switch for weight loss failure and symptoms. Surg Obes Relat Dis. 2015 Jan-Feb;11(1):259-61. doi: 10.1016/j.soard.2014.09.003. Epub 2014 Nov 28. PMID: 25595920.

Smeets FGM, Strijbos D, Keszthelyi D, Hoge CV, Kruimel JW, Conchillo JM, Masclee AAM. Endoscopic Botulinum Toxin for Gastroparesis: Results of a Retrospective Series. Gastrointestinal Disorders. 2019; 1(1):164-175. https://doi.org/10.3390/gidisord1010012

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