The gastric bypass procedure can ultimately fail for several reasons, the most common of which is gastric pouch dilation, where the stomach increases in size over time. Of course, as the stomach gets bigger, the patient is able to eat more. During the primary gastric bypass procedure, the stomach is reduced to about 20% of its original size. But the stomach is a very flexible organ and, with improper aftercare, can increase in size. If pouch dilation does, in fact, occur it usually becomes apparent several years after the procedure. Other less common reasons for a revision can include a stricture, where scar tissue partially blocks the opening to the small intestine and serious dumping syndrome.
The gastric bypass, like all bariatric surgery procedures can be revised. Since the gastric bypass affects both the stomach and small intestine, there are fewer options to definitively restore the previous function than the gastric band or sleeve. The most commonly performed revision to a gastric bypass is the duodenal switch, which itself is sometimes used as a primary procedure. The duodenal switch essentially reactivates the portion of the stomach that was cut away. The duodenal switch procedure maintains the bypass’s combination of restriction and malabsorption.
Dr. Duncan has also developed a proprietary revisional technique that minimizes risk and pain while restoring most if not all of the gastric bypass’s restriction and malabsorption.
Patients in need of revision will usually come to our office complaining of significant weight regain. Before any revisional bariatric procedure, it is critical to ensure that the weight regain is indeed caused by something other than overeating. For that reason, patients should come to our office prepared with a food journal detailing a week or more of meals and exercise. Once the determination has been made that it is not a behavioral issue, we will be able to discuss surgical options. If, indeed, the patient has lost their way in the post-bariatric diet, we offer a comprehensive back-on-track program to help return them to their former regimen.
A revisional surgical procedure should be undertaken only when all other options are exhausted since there is a greater risk of complications. Please contact our office to schedule a consultation and understand more about the surgical options to correct weight regain.