What does revision bariatric surgery mean?
Revision weight loss surgery is performed when there has been previous weight loss surgery.
Who would need revision surgery?
Unfortunately, a subset of patients who have had bariatric surgery in the past require further surgery to help put things right.
Common indications for revision surgery
Severe acid reflux (heartburn) following a prior restrictive procedure
Failure to loose sufficient weight, or weight re-gain
Other complications of surgery such as slippage, leakage or erosion of a gastric band, and 'mega-oesophagus' associated with a gastric band
Severe acid reflux
Reflux of acid from the lower stomach up to the oesophagus is a relatively common side effect of restrictive procedures like the gastric band and the sleeve gastrectomy. There is a complex relationship between gastric sleeve surgery and reflux. For instance, some patients with heartburn before surgery will find it diminished or gone after a sleeve gastrectomy because their reasons for reflux before were most likely a small hiatus hernia (which gets repaired at their sleeve operation) and increased abdominal pressure (which improves as they loose weight). Others, however, could have their symptoms worsened or appear after surgery. This will occur in around 15% of patients and will need to be managed. Mostly, this will be taking an anti-acid tablet with occasional check endoscopies. If the acid is damaging the oesophagus, it is dangerous to leave it like that long-term, so revision surgery might be required.
The usual procedure recommended for revision surgery for reflux would be a conversion to the Roux en Y Gastric Bypass because this has the effect of diverting the acid away from the oesophagus, as well as being an excellent weight loss procedure.
Failure to loose weight or weight regain
Unfortunately, with any weight loss procedure, there are a small number of people who loose insufficient weight, or who, after some time, put weight back on again. This can occur due to a number of reasons, of course. These include: poor eating and exercise habits, stretching of the stomach over time, and technical or surgical failures to get the operation right the first time.
It is not uncommon for patients with a gastric band to fail over a long time period because the strong anti-appetite effect of the band seems to reduce over time. Dr Crawford and your dietitian will need to spend some time trying to understand why things didn't work out to avoid the same problem in the future. A Sleeve Gastrectomy can work well, but for some (particularly those not having good appetite suppression any more from a band), this purely restrictive operation may not be as effective as it is for first time surgery. One of the bypass operations may well be the best bet.
For those who have had limited success with a previous Sleeve Gastrectomy, Dr Crawford will usually recommend a bypass operation.
Some surgeons will occasionally perform a 're-sleeve' if the original sleeve is dilated, or was not performed radically enough, but this is not Dr Crawford's usual practice.
Gastric Band to Sleeve Gastrectomy
This is a common option for patients who have previously had a gastric band placed but where it needs to come out for whatever reason. Even patients with reflux with Gastric Band will usually be better off with a Gastric Sleeve. If this option is chosen, Dr Crawford generally recommends a three month wait between removing the band and having the sleeve. This is to allow for all the scar tissue from the band to settle down and make the surgery safer. He will, however, offer Band to Bypass in a single operation, but on the understanding that if the scar tissue would make that too dangerous, then a delayed bypass would be best.
Cost of Revision Bariatric Surgery
Revision Bariatric Surgery is difficult surgery. Not every surgeon can perform this well and safely. Furthermore, it takes longer to perform and is associated with a little more risk. For all of these reasons Dr Crawford charges new revision patients a little more than new 'primary procedure' patients. He looks after his own previous patients free of any out of pocket charge.
Please note that it is often necessary to perform diagnostic tests such as an Upper GI series (XRAYs), CT scan and endoscopy prior to making the final decision about surgery. While these are not very expensive they may add to the costs.
The exact cost of revision surgery will very much depend on the exact circumstances and can only be determined after a consultation with Dr Crawford, but total out of pocket expenses of around $6000 for insured patients should be anticipated.