Revisions


Dr. Nowzaradan holds a specialty in the bariatric technique of revision surgery. Revisional bariatric surgery may be needed if a single bariatric procedure yielded less than optimal weigh loss results, approved less than optimal resolution of co-morbidities,  or if there is an occurrence of medical complications related to the initial weight loss surgery. Revisions surgery is highly specialized. Studies caution that revision surgery should only be performed by a surgeon proficient and experienced in this specialized, more about unpredictable class of bariatric procedures.

It is important to carefully consider the surgical options available and to discuss your goals and expectations candidly with the doctor. Usually, for most patients, a single procedure will yield satisfying results, but occasionally, complications will have occurred with a previous surgery, adjustments may be made to enhance or supplement a prior surgery, or corrections may be necessary from a previous surgical procedure.

Revision surgery is seldom as straightforward and prescriptive as the initial surgical procedure simply because, as the nature of the name implies, a revision is being performed because an initial, standard procedure did not work as forecast.

Years ago, when bariatric surgery was in its infancy, weight loss surgeries were commonly associated with revisional surgeries. Today’s gold standard procedures, the Roux-en Y and the Lap Band system, while enormously more successful, also require occasional revision. Poor weight loss, weight regain, ulcers, or band slippage are common reason for revisions for the most commonly performed procedures today.

Revision rate for the Lap Band System is approximately 10% during the first two years for either device-related problems or unsatisfactory weight loss.

Revision rate for gastric bypass, including Roux-en Y is about 5-10% over 5 years for either troublesome complications or unsatisfactory weight loss.

Typically, insurance companies promptly approve revision procedures as long as the patient is able to adequately demonstrate the presence of post-surgical complications. In the instance of weigh regain, or unsatisfactory weight loss, insurance approval is generally less expedient than for complications, which may immediately effect a patient’s health. Insurance qualification due to weight regain is typically very similar to that originally required for the initial procedure.

The results of revisional surgery can vary widely and are greatly dependant on the reasons for seeking revision. In the hands of an experienced bariatric surgeon, the results of revisions for complications are generally good. This means that the complication is corrected and the associated problems are resolved. Weight loss following revisional procedures is generally less dramatic than following the primary operation. This is primarily because patients who have revisional surgery for weight loss failure have considerably more difficulty losing weight. The results also depend on the original bariatric procedure. Many patients who have failed either gastroplasty or Lap Band procedures have fairly good weight loss after conversion to Roux-en-Y gastric bypass. Conversely, patients who fail gastric bypass tend to lose less weight following conversion to a more malabsorptive bariatric procedure. Patients who seek revision due to staples that have become unsecured, or “popped”, usually do well when this situation is repaired.

Historically, revisional bariatric surgery has been relatively high-risk. Two decades ago, the overall complication rate approached 50% with a mortality rate as high as 5-10% in some published reports. During the past ten years, these results have improved dramatically. Still, it is generally acknowledged that general surgeons with little bariatric experience should not perform revisional bariatric procedures. Several recent publications emphasize the learning curve associated with improved outcomes. The most experienced surgeons obtain the best results following revisional bariatric operations. Dr. Nowzaradan has performed many revisions and is widely sought after for his accomplishments and experience in this specialized area.

Revisional surgery remains typically higher risk than the initial procedure simply due to a few key reasons. Patients undergoing revision tend to be under anesthesia longer than for the initial procedure, revisions are more complicated, and less predictable than the initial procedure, and each patient’s surgical requirements are highly unique. There may be a higher incidence of leakage or infection in revision, in part because these factors may be the primary reason for revision. Tissue that is damaged from an ineffective initial procedure may heal less quickly. Also there is a greater instance of a revisional procedure needing to be open rather than laparoscopic, creating the potential for greater blood loss. Wherever possible, Dr. Nowzaradan will perform revisional surgeries laparoscopically. In fact, Dr. Nowzaradan pioneered many surgical techniques using laparoscopy; proving to many medical professionals that procedures once considered impossible to perform laparoscopically could indeed be done safely and effectively.

Revisional surgery is best approached from a highly individualized basis to successful outcome. Especially if continues or improved weight loss is the goal.