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Do I Need Revisional Weight Loss Surgery?

Do I Need Revisional Weight Loss Surgery?

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      A growing number of weight loss surgery patients are considering revisions due to relapse years after. The primary reason is due to inadequate weight loss, and even weight regain. Numerous factors can impact the patient’s weight progress. Firstly, many patients will realize they may not have chosen the most efficient option to address their obesity. For instance, those who opted to get a gastric band now understand this choice did not provide maximum weight loss potential. Some will admit to unhealthy behavioral habits due to unforeseen situations that led to this outcome. Even more, the body’s anatomy changes over time, which can cause chronic discomfort and interrupt how your food intake and energy are processed.

      Regardless of the circumstances, it is essential to recognize the problem and get back on track. For some, getting extra help from a support group or a professional is enough, while others may benefit from bariatric revision weight loss surgery to help with restarting the weight loss process and treating any complications from the initial procedure.

      Measuring tape laying on a digital scale.
      If you have relapsed after bariatric surgery, then revision weight loss surgery may be for you.

      What are the weight loss surgery revision options?

      Choosing the most appropriate bariatric revision depends on what was done initially. The surgeon will first need to evaluate the health of your gastrointestinal tract, starting from the esophagus to the small intestine. Lastly, he/she will recommend the best option for you once all the information is gathered.

      Table with weight loss surgery information.
      Table of the different revision weight loss surgery options.

      In many cases, revisions are done from previous gastric band procedures, which is an adjustable silicone band placed around the top portion of the stomach. The band is “adjusted” or filled periodically to promote food restriction by injecting saline through a port placed under the skin.

      This was a popular procedure due to the fact it is reversible and does not require any removal and rerouting of the stomach or intestine. Over time, the band has shown to be ineffective for long term weight loss. Depending on your current weight and health status, a revision to the other bariatric surgical options may be possible such as a gastric sleeve, a gastric bypass, or a duodenal switch.

      In addition to insignificant weight loss, other common complaints from gastric sleeve patients include painful gastroesophageal reflux disease, also known as GERD and uncontrollable diabetes. Revision to the gastric bypass has shown to resolve these issues as a result.

      The duodenal switch consists of a gastric sleeve and an extensive bypass of the intestines, which exceeds both short- and long-term weight loss outcomes. Thus, conversion from gastric bypass surgery to the duodenal switch has become prevalent due to failed weight loss or weight regain. Other gastric bypass revision weight loss surgery includes reinforcing the restrictive component by using a band or staples around the stomach to limit food intake or altering the bypass component by shortening the common channel, which will significantly decrease food absorption. Therefore, this will help the patient lose more weight.

      While the duodenal switch has its upside, it has disadvantages as well. Due to its malabsorptive nature, some patients struggle with protein and vitamin deficiencies. Consequently, these patients may benefit from partial revision of the duodenal switch by lengthening the common channel, which can improve absorption.

      What are the potential risks from revisions?

      Man holding stomach in pain.
      There are several risks when it comes to bariatric revisions.

      All bariatric surgeries have risks and complications that may occur post-operatively, such as bleeding, acid reflux, hernias, or vomiting. These risks still apply for bariatric revisions. They might be more heightened due to previous scarring and current health status of the stomach and intestine. Some studies have suggested that revision patients have shown higher risks of complications than the first weight loss procedure. While revision weight loss surgery is done laparoscopically, patients should be educated on all potential risks.

      Does my insurance (even Medicare) cover revisions?

      People in a medical office reviewing information on a computer.
      Bariatric patients can get insurance approval for revision surgery.

      Bariatric patients who had to get approval from their insurance providers the first time will remember they had a checklist to complete. Some lists were more extensive and took longer to complete, while others had an easier time. Undoubtedly, those seeking revisional surgery can expect a more rigorous approval process.

      Coverage for revision weight loss surgery varies among plans and by state. For the most part, the general requirement for revisions are:

      • Presence of medical complication(s) of the initial bariatric surgery
      • BMI greater than 40 with failure to lose at least 50% of excess body weight
      • BMI greater than 35 with at least one clinically significant obesity-related health condition and inability to lose at least 50% of excess body weight

      Luckily for Medicare patients, revisions are covered if they find your case to be medically necessary. As for everyone else, if your insurance does cover revision weight loss surgery, you want to be aware of all the required documentation required before submitting the claim. It is important you and your surgeon understand the plan for your potential revision. Any tests, imaging, and consultations the surgeon prescribes all need to be completed and followed through before submission. Even more, patients will need to prove that revisional surgery is required clinically despite all efforts such as following a controlled diet plan and regimented exercise schedule.

      What if my insurance does not cover any bariatric surgery?

      Maybe you switched jobs since the first surgery, and now your new policy does not cover any bariatric surgery. Can it still get done? Yes. Even though your argument might be more challenging to prove, it is possible. No matter what the journey brings you, be persistent, and do not give up.

      How much does revision weight loss surgery cost?

      Man sitting outside thinking.
      You have to think about the costs associated with revision weight loss surgery beforehand.

      If you choose to self-pay, fees depend on the procedure. For instance, the cost of revision weight loss surgery from a gastric band to sleeve will be less than a revision to a gastric bypass. Additionally, the price can vary among practices. It is best to call around and ask for self-pay rates as this information is readily available.

      In conclusion, making behavioral and lifestyle changes in conjunction with bariatric revision surgery can make a positive impact on reaching your weight loss goal. Remember, surgery is not a “cure” to obesity. It is a tool that needs to be used properly with adequate dietary and appropriate exercise regimens. If you feel something is “off” with your body or notice an old unhealthy habit resurfacing, seek your medical team to address the issues promptly.

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        Eun Jung Park, MS, RD

        Author

        Eun Jung Park is a registered dietitian with over 10 years experience working in various clinical settings. She graduated from New York University with an Master of Science in Nutrition and Dietetics.

        Gintas Antanavicius, MD, FACS, FASMBS

        Medical Reviewer

        Dr. G is a co-founder of BariBuilder. A US-based expert surgeon with over 10 years of bariatric experience, he regularly publishes research in medical journals like SOARD, Obesity Surgery, etc.