مراجعة جراحة فقدان الوزن بالمنظار
This is revision surgery following a previous weight loss procedure, and it aims at either treating a complication or achieving further weight loss when a previous procedure has not been quite successful or failed.
Revision weight loss surgery to treat a complication could involve:
The need for revision weight loss surgery to aid weight loss and the choice of surgical procedure is dependent on discussion with an experienced bariatric surgeon and the bariatric team, particularly the dietitian, who will provide you expert and comprehensive advice.
- Laparoscopic repositioning of gastric band due to pouch dilatation or band slippage.
- Laparoscopic removal of gastric band due to band erosion, band slippage, or severe acid reflux or oesophageal (gullet) dilatation.
- Laparoscopic revision of the gastrojejunal anastomosis (the joint between the stomach and intestine) of a previous gastric bypass due to recurrent ulceration or to severe stricture (narrowing).
- Laparoscopic reversal of the bypass element of a duodenal switch in those who suffer with severe malnutrition that did not respond to other supportive measures.
Revision weight loss surgery to achieve further weight loss due to failure of previous procedure or due to weight regain could involve:
- Laparoscopic removal of a failed gastric band system and conversion to gastric bypass or to sleeve gastrectomy.
- Laparoscopic conversion from a previous open gastric stapling procedure, such as the vertical banded gastroplasty (VBG) to gastric bypass.
- Laparoscopic conversion of sleeve gastrectomy to a gastric bypass or duodenal switch procedure.
- Laparoscopic revision surgery for weight regain following previous gastric bypass, and could involve one of the following options:
- Placement of a gastric band around the gastric pouch
- Revision of the gastric pouch to reduce its size and the size of the stretched gastrojejunal anastomosis (the joint between the stomach and intestine)
- Conversion to a “distal” gastric bypass, which involves the bypass of more of the small intestine in order to induce further degree of malabsorption along principles similar to those of a duodenal switch procedure.
- Laparoscopic conversion of gastric bypass to duodenal switch procedure.
Yes. In addition to the general preoperative-assessment routine blood tests, special tests will need to be performed to determine the following:
- The exact nature of your previous weight loss surgery (for example, a previous vertical banded gastroplasty or open gastric bypass)
- The nature of any complication that might exist in relation to previous weight loss surgery
- The extent of possible stretching and dilatation of gastric pouch after previous gastric banding, the gastric pouch and/or gastrojejunal anastomosis of a previous gastric bypass, or gastric tube of a previous sleeve gastrectomy.
Your experienced surgeon will determine which specific tests are required, but often these will include one or more of the following:
- Barium meal (X-ray of the stomach and intestine where a contrast material called barium is swallowed)
- Gastroscopy (camera examination of the stomach under sedation)
- Ultrasound or a CT-scan of abdomen to investigate the possibility of gallstone or a twist of the intestine.
The surgery is performed under general anaesthesia using keyhole (laparoscopic) surgery. Small incisions are created in the abdominal wall to allow small instruments to be passed into the abdominal cavity, guided by a special surgical telescope with a video camera, in order to perform the operation. Adhesions from previous surgery are carefully divided in order to facilitate exposure, and the revision operation is then performed.
Most patients will be able to go home within 1-2 days after surgery depending on the complexity of the operation, their health issues, especially their mobility, and the availability of support at home.
As with any surgical operations there are associated short and long-term complications such as internal bleeding, anastomosis leakage, blood clot in the legs (deep vein thrombosis; DVT), blood clot in the lung (pulmonary embolism), infection, malabsorption of vitamins and micronutrients (which may lead to anaemia, weakness, osteoporosis and neurological problems), internal bowel hernia (less than 1%), ulcer perforation (0.8%), and weight regain.
However, Professor Basil Ammori (based in Manchester, UK) has performed over a hundred complex revision procedures with good results and with no anastomotic leak or mortality to date. Read more in Professor Ammori’s publication on this subject: Revision laparoscopic gastric bypass: an effective approach following failure of primary bariatric procedures. Hamza N, Darwish A, Ammori MB, Abbas MH, Ammori BJ. Obesity Surgery 2010; 20(5):541-548.
Professor Basil Ammori always gives his personal number to all his private patients (this is in addition to the contact numbers of the bariatric nurse, dietitian and the ward) so that they might reach him without delay in case of emergency.
With any weight loss operation, including revision surgery that is aimed at inducing further weight loss, a small proportion of people might not achieve the desired weight loss or could regain weight in the long term. The stomach could stretch again, the hunger could return, the intestine adapts and the dumping fades away. It is essential therefore to adopt a healthy life style and carry it on for a durable result.