Candidates are patients who have previously undergone gastric bypass surgery and have not seen sustained, significant weight loss after significant changes in diet and exercise. Some patients may also be suffering from more severe side effects of gastric bypass such as ulcers, bowel obstruction, significant GI upset (vomiting, diarrhea, nausea, and heartburn), kidney stones, anemia, stomach bleeding, or vitamin deficiency. As gastric bypass revision is a higher-risk surgery than gastric bypass, more specific factors pertaining to an individual case will also determine candidacy.
Patients who have undergone gastric bypass surgery but who have failed to sustain long-term permanent lifestyle and diet changes are not candidates for gastric bypass revision.
A period of consultation to determine how and if your gastric bypass has failed is required prior to gastric bypass revision. During this period, upper endoscopy (insertion of a small camera), radiography (tracing a safe radioactive dye you swallow), and/or an eating test (observing you eat and see how quickly it takes for you to become hungry again) may be conducted to determine where the gastric bypass has failed.
Depending on the type of revision surgery you intend to pursue, preparation may differ. For more invasive surgery procedures such as conversion to duodenal switch, addition of a lap band, or lengthening of the Roux limb, you may be required to undergo certain general surgery procedures such as preoperative blood testing, medications, and cessation of smoking or use of pain relievers and anti-inflammatory drugs. For a less invasive procedure like usage of the Stomaphyx or injection of sclerosants to shrink the stoma, there may be less preparation, as patients typically are able to return home on the day of the procedure.
For more invasive surgery procedures, recovery can take 2 to 8 weeks. Recovery is a slow and gradual healing and readjustment process. In comparison, stoma shrinkage usually has a recovery time of just 1 day. In either case, diet and activity level still need to be altered.
For more invasive surgery procedures, pain in the first 2 to 3 days after surgery in the upper left part of the abdomen is common, but can be managed with pain relievers. Pain should be minimal to nonexistent by 2 to 3 weeks after the surgery. Although light walking is suggested soon after surgery, strenuous exercise should be avoided for the first few weeks. Patients should stick to an all-liquid diet for the first two weeks, before gradually easing into soft foods and eventually back to a normal diet four weeks post-surgery. However, portion sizes should be heavily restricted and patients should eat slowly so they can properly gauge their fullness. Lifestyle changes implemented before the surgery should be maintained in the long run as patients adjust to eating smaller portions.
Gastric bypass revision surgeries carry the same risks of other open surgeries performed under general anesthesia, such as adverse reactions to anesthesia, infection at the wound site, allergic reactions to medication, and blood loss requiring transfusion. Aside from stoma shrinkage, gastric revision has a higher risk profile than other weight loss procedures, due to level of invasiveness and demonstrated higher risk of complications. Risks of using Stomaphyx to shrink the stoma in particular including bleeding and perforation, but are generally much lower than the other methods of revision.
Long-term side effects include dumping syndrome, malnutrition from reduced nutrient absorption, diarrhea and nausea, and vitamin B12, iron, calcium or magnesium deficiency. Rare but fatal complications include small bowel blockage from pancreatitis, and pulmonary embolism.
$23,000+ (similar to original gastric bypass)