Often, bariatric surgery patients will lose a significant amount of weight and they often experience the remission or complete elimination of obesity-related conditions such as type 2 diabetes, sleep apnea, etc. Many can maintain their new behavioral habits and sustain their weight loss; however, most patients regain about 30% of the weight they lost and one in five will gain all the weight they lost and sometimes more.
The good news is that there is help for these patients. Today, we will talk about some reasons that patients experience weight gain after bariatric surgery, how endoscopic revision can help, and the different processes used for the revision of bariatric surgery.
Why Do Many Patients Regain Weight After Having Bariatric Surgery?
According to statistics, out of all the patients who undergo bariatric surgery, about half experience weight regain within the first two years. Many factors can contribute to weight gain and it is not always a matter of a lack of willpower on the patient’s part. Some of these factors may include the following:
- The body’s survival instinct
- Our metabolism instinctively tries to adjust to our calorie intake to keep us alive, so when we eat fewer calories, it deliberately slows down to conserve energy. This sabotages our efforts at weight loss.
- The initial surgical procedure was not a good fit
- Sometimes, the type of bariatric surgery that was initially performed was not the best procedure for that patient.
- Unpleasant Side Effects
- Sometimes, a patient may experience chronic side effects like GERD or acid reflux and the patient will seek a revision to correct these.
- Enlarged stomach pouch
- Patients can increase their food intake and gradually stretch out their stomach pouch over time. This allows the pouch to hold more food, which promotes overeating, which continues to enlarge the pouch until it is no longer offering the restrictive measures that promote weight loss.
- Anatomical changes
- Sometimes, the body will adjust to the changes that were made during the initial procedure. The most common complication after bariatric surgery is an enlargement of the connection between the stomach and the small intestine (gastrojejunal stoma). When this occurs, the restrictive nature of the initial bariatric surgery is eliminated.
- Poor Stress Management
- Cortisol is a hormone our bodies produce in response to stress. This hormone promotes the storage of fat, which obviously is not what weight loss patients desire.
- The Patient’s Choices
- We all know life happens and sometimes it is easy to revert to our old habits. Comfort eating, choosing to return to a sedentary life, etc. lead to weight regain.
When Should You Consider A Bariatric Surgery Revision?
Patients who are experiencing weight regain should seek help before the situation gets out of hand. Many times, patients do not understand what is causing them to gain weight because they are doing everything they are supposed to do. Other times, patients understand they have slipped back into old, counterproductive patterns but are too embarrassed to seek help.
Weight loss professionals have dedicated their careers to supporting patients so they can achieve maximum health and an improved quality of life. They do not want these patients to become discouraged or overwhelmed, despite the reasons for the weight gain.
They desire to help these patients get back on track as quickly as possible, which can often be done through a bariatric revision procedure. The sooner the patient seeks help, the sooner the weight gain can be stopped.
What Is A Bariatric Revision Procedure?
When an individual begins to regain the weight they lost after bariatric surgery or are experiencing side effects from the surgery which is affecting their quality of life, a bariatric revision procedure may be done to correct the issue.
Bariatric revisions may be performed surgically or non-surgically, and the type of revision that will be needed will vary depending on the underlying cause of the issues. Most patients can successfully undergo a non-surgical bariatric revision procedure to correct their weight gain.
What Options Are Available For A Bariatric Revision?
Options for a bariatric revision procedure will depend on which type of bariatric surgery needs revision and how much repair may be required. Some patients will only have the option of undergoing an additional surgery, but most issues can be corrected without surgery.
Options For Former Gastric Bypass Patients
Duodenal Switch Surgery
In some cases, a patient who has had gastric bypass surgery can be converted to a duodenal switch bariatric surgery. Duodenal switch surgery is the most invasive and life-changing type of bariatric surgery and it is usually reserved for the most extreme cases.
Duodenal switch surgery is complex and when used as a revision for gastric bypass surgery, is associated with more risks than if undergoing either surgery for the first time. After duodenal switch surgery, patients are at high risk of malnutrition and the complications associated with it.
Most bariatric revision corrections can be effectively done without invasive surgery.
Transoral Outlet Reduction (TORe)
TORe (Transoral Outlet Reduction) is done to correct weight gain in patients who have previously had bariatric gastric bypass surgery. TORe is not a surgical procedure and is performed using an endoscope.
An endoscope is a narrow, flexible tube that is inserted down the patient’s throat and used to provide a pathway for special tools to be used to perform a procedure from the inside as opposed to laparoscopically.
The TORe procedure takes about 30 to 45 minutes to perform and involves the following steps:
- The patient is mildly sedated.
- The endoscope is gently placed down the throat to access the area (gastric outlet) where the small intestine joins with the new, smaller stomach (gastric pouch).
- A special suturing tool is guided down the endoscope and used to place small sutures in strategic locations, which makes the gastric outlet smaller and closes it off a bit more. This will restore the “full” feeling the patient gets after eating just a small amount of food and help them begin losing weight again.
- There is no hospital stay required after a transoral outlet reduction procedure and there are no incisions, so recovery for most patients only takes a few days.
Another less-commonly used option for the revision of bariatric gastric bypass surgery is a series of injections called sclerotherapy. This procedure is also done endoscopically from the inside and aims to shrink the size of the connection between the small intestine and the stomach pouch. When this connection becomes stretched, it allows more food to be ingested by the patient and does not provide the feeling of satiety, so patients tend to overeat and gain weight.
Sclerotherapy takes about 30 minutes to perform and involves the following steps:
- The patient is given a mild sedative.
- The surgeon carefully lowers the endoscope down the patient’s throat.
- Another special tool is lowered down the endoscope and is used to place an injection (or a series of injections) containing sodium morrhuate. These injections can reduce either the capacity of the stomach pouch or the size of the opening. This helps patients become satisfied faster when eating and they feel full longer.
- There is still controversy over the injections because they are not as effective as TORe and also carry a longer recovery time.
Options For Former Gastric Sleeve Patients
GSRE, or gastric sleeve revision, can correct the issue when a patient’s stomach becomes stretched out. When this happens, the restrictive nature of the initial gastric sleeve surgery no longer occurs and patients eat too much and gain weight.
Some patients might require a surgical conversion to bariatric gastric bypass surgery, but most patients will qualify for a non-surgical procedure that poses fewer risks and offers a much shorter recovery time.
Non-Surgical Gastric Sleeve Revision Options (GSRE)
During the initial gastric sleeve surgery, a portion of the patient’s stomach is surgically removed, the remainder is shaped into a sleeve-like pouch, and the edges are surgically stapled.
GSRE is a procedure that is done through an endoscope to tighten a previous gastric sleeve surgery so it begins to restrict the intake of food once again. The steps of the non-surgical gastric sleeve revision are as follows:
- The patient is given a mild sedative.
- The surgeon lowers the endoscope down the patient’s throat to reach the stomach pouch.
- Next, sutures are used to reshape the stomach pouch until it is restored to its smaller size, similar to just after their initial bariatric gastric sleeve surgery. The weight gain should stop and the patient should begin losing weight again.
Another non-surgical remedy for revising a former gastric sleeve surgery is called a gastric sleeve in sleeve (SIS). This procedure is also performed through an endoscope and corrects the laxity of the stomach pouch, or a pouch that was initially left too large to promote significant weight loss in the patient.
The SIS procedure is performed with the following steps:
- The patient is sedated.
- The surgeon inserts an endoscope with a special tool in the patient’s mouth and down their throat until it reaches the gastric sleeve pouch.
- The special tool is used to strategically fold and fuse the stomach together in different places until the sleeve becomes smaller.
SIS normally takes under an hour to perform and since there are no incisions, there are no visible scars. Patients also recover much faster than after bariatric surgery.
What Is The Cost Of A Bariatric Revision?
Many factors are considered when determining the cost of a bariatric revision. Some of these factors include the following:
- The type of initial bariatric surgery that is being revised
- The method that is being used to revise the initial procedure
- The overall health of the patient
- The geographical location of the specialist’s practice
- The expertise of the specialist
Bariatric Revision Can Quickly Stop Weight Regain
Although many patients experience successful and sustainable weight loss after bariatric surgery, there are some cases where patients begin to experience permanent plateaus or they begin gaining weight. A bariatric revision procedure can address the underlying causes that rendered the previous weight loss procedure ineffective.
If you have had bariatric surgery or another weight loss procedure and you are experiencing weight regain, do not wait to ask for help. The experts at Simmons MD Advanced Weight Loss Solutions are here to help the weight gain stop and get you back on track.
There is no reason to be embarrassed or allow the situation to escalate. We understand that sometimes life happens and we are here to support you through it. You are not alone! Contact us today to learn more about bariatric revision and how it can help you stop gaining weight and get back on track with your weight loss journey.