There may be a few different reasons patients that have previously had gastric bypass surgery would seek revisional weight loss surgery. The most common being lapband removal.
Perhaps, there was a complication or simply failed weight loss.
Bad behavior often leads to small pouch stretching which then allows more food intake. Simple lifestyle changes can help make your surgery successful.
Learn reasons you may require revisional surgery and how you can help avoid the bad behavior that may be the cause.
Selected Podcast
Correcting Previous Surgical Weight Loss Procedures
Featured Speaker:
Before joining Summit Medical Group, Dr. Bell was Founder and Medical Director of the Yale - New Haven Hospital Bariatric Surgery Program and Medical Director of the Yale - New Haven Hospital Minimally Invasive Surgery Program. To his credit, Dr. Bell also established and has been Director of the Yale Minimally Invasive Surgery Fellowship Program.
Robert Bell, MD
Robert Bell, MD, MA, FACS, has expertise in bariatric surgery for morbid obesity. Dr. Bell also specializes in minimally invasive laparoscopic and endoscopic surgery for gastroesophageal reflux disease, gallbladder disease, esophageal motility problems, abdominal wall hernia repairs, and other gastrointestinal (GI) problems. A leader in bariatric surgery and minimally invasive surgery, he is among few surgeons in the New York metropolitan area who perform revisionary (corrective) obesity surgeries. In addition to his position at Summit Medical Group, Dr. Bell is Associate Professor of Surgery at Yale University School of Medicine in New Haven, Connecticut.Before joining Summit Medical Group, Dr. Bell was Founder and Medical Director of the Yale - New Haven Hospital Bariatric Surgery Program and Medical Director of the Yale - New Haven Hospital Minimally Invasive Surgery Program. To his credit, Dr. Bell also established and has been Director of the Yale Minimally Invasive Surgery Fellowship Program.
Transcription:
Correcting Previous Surgical Weight Loss Procedures
Melanie Cole (Host): Patients that have previously had gastric bypass surgery, they might seek revision weight loss surgery for a few reasons. Maybe their surgery didn’t help them lose the weight that they wanted, or it just wasn’t enough to help them get past that really tough problem. My guest is Dr. Robert Bell. He’s a bariatric surgeon with Summit Medical Group. Welcome to the show, Dr. Bell. Tell us about revision surgery. Why might some people that have had gastric bypass bariatric surgery, needed to lose maybe 80 or 100 pounds, had to go back in? Because my sister had lap band over bypass, so I know something about this. Tell us why people might have to do this.
Dr. Robert Bell (Guest): Well, that’s a great question. Actually, by far, the most common revisionary surgery done today is actually lap band removal and conversion to something else. So your sister has the exact opposite thing happened, but that would be the one in 100 bariatric surgical procedures as opposed to the other 99 out of the 100 bariatric surgical procedures are actually the most common revisionary bariatric surgery is going to be lap band removal, for one reason or another. But in general terms, the most common reason to perform a revisional weight loss surgical procedure is failed weight loss. The second most common reason to perform a bariatric surgical revision would be a complication from the original procedure. When it comes to lap band, lap bands can slip. Lap bands can erode. Lap bands can have port side infections. Those are very common reasons to remove the band. Another thing that is fortunately not as common is esophageal dilatation that can occur after the introduction of a lap band. That would be another reason to have it removed. That is a complication. But even though I said all those scary things, the most common reason for lap band removal is failed weight loss. But the other weight loss surgical procedures, as you know sort of from personal experience, also may need to be revised down the line, whether it’s gastric bypass or sleeve gastrectomy. Again, the most common reason for revising a gastric bypass or sleeve gastrectomy would be for failed weight loss. The next most common reason would be for a complication of either of those operations.
Melanie: So after the surgery, and let’s start with gastric bypass. It’s a big surgery making the pouch. Now, there’s a certain compliance that goes along with after surgery. And if that compliance, the pouch, it can grow bigger again or something, as I understand it, correct? So if the compliance isn’t there, speak about why somebody might need additional surgery after that one, and then we’ll talk about the lap band.
Dr. Bell: It’s a great way that you put the question, and that is just because one is full doesn’t mean that one is not going to eat. You would think that that’s just common sense. But instead, some people -- and again, it can be cultural and it can just be years of bad habits that can creep back in. Just because you have a small stomach doesn't mean that you’re not going to out-eat. Really, the reason why bariatric surgical patients, whether it’s sleeve gastrectomy, gastric bypass—and we’ll get to lap band later—the reason why they can eat more, it really has to do with more like a grazing behavior. So they’re eating little bits of calories all day long, and it’s certainly possible that the pouch stretches a little bit. But what is far more probable is that the person, through their bad behaviors, their maladaptive behaviors, sort of trains the food to go from a very small pouch to the small intestines faster. And we all have about 20 feet of small intestines, so if you strain yourself—I’m going to use that word—to eat a little bit more, a little bit more, a little bit more, you’ll actually force the food from the very small pouch into the small intestine, and really, will enable you to eat, I don't want to say an unlimited portion, but it will enable you to eat a big portion. It’s not so much that the pouch has grown per se. It really has to do with the food emptying out of the pouch faster.
Melanie: So, if somebody does that, and so the adherence to all of those behavioral lifestyles has really not changed because they’re sort of back to eating, maybe they can’t eat as much at once, but they’re eating more throughout the day little, little, little, little, and filling up their small intestine. So then they’re not losing the weight and possibly even having some malabsorption issues, correct?
Dr. Bell: Well, they’re not going to lose the weight if they’re eating frequently throughout the day. And again, that’s a habit that needs to be addressed. So it’s very important that we talk in these terms to patients. In general, primary, meaning first-time weight loss surgery has a success rate of 80 percent, about four out of five. That’s pretty good. You take the 20 percent and then submit them to revisional surgery. Really, the success is about 50 percent, so it drops pretty significantly. The reason why it drops is because even though patients will tell everybody, they will tell me and they’ll tell the psychologist that okay, now, they’re going to change their behavior, really, only about one in two will actually make those changes, and the other one in two will continue along with those maladaptive behaviors that will put the weight on. There really is no operation for grazing behaviors, eating throughout the day and there’s no operation for people who are not going to get off the couch. So really, those behaviors need to be addressed, and we’re very serious about that when we talk to patients before revisionary surgery, talk and say, “Listen, you’ve already been through this once. You know what behaviors are good behaviors, and hopefully, you’ve learned which behaviors are bad behaviors. So it’s really important that you not just have surgery. You’re going to get 20, 30, 50 pounds off right away. Then, what are you going to do? What’s next? Are you going to eat right and exercise, you’re going to fall back into that habit?” And so you want to really make sure these patients are educated before undergoing any type of revision or any procedures.
Melanie: Well, so speak about lap band a little bit, Dr. Bell, because lap band is done laparoscopically. It’s a bit of an easier surgery, as you said previously. You can get back even into activity after a day or two, at least to start walking. So speak about lap band and why might that not kind of hold and work for somebody?
Dr. Bell: Yes. You make no mistake. The first laparoscopic gastric bypass done in 1994 was done well before the first laparoscopic gastric band. It’s just a marketing term. You know, lap band, oh, that’s done laparoscopically. All bariatric surgery procedures are done laparoscopically, or all can be done laparoscopically. And again, about 95 percent of all bariatric surgical procedures are done laparoscopically—laparoscopic gastric bypass, laparoscopic sleeve gastrectomy. So a lap band is basically placing a silastic ring around the top part of the stomach, and that ring is connected to a tube, which is connected to a reservoir that sits underneath one skin. And that reservoir needs to be accessed by way of a very, very long needle. What you can do is you can adjust the outlet from the stomach into generally the normal stomach by putting food in or out of that reservoir. So it’s an operation that has been shown -- again, statistically speaking, of course there are individuals all over the place. But statistically speaking, it has the worst weight loss of any weight loss surgery operation, and there certainly is a growing sentiment that any lap band that gets put in is ultimately going to need to come out at some point. Again, the band is made of plastic, and everybody that has a knee replacement would know that well, that titanium knee is not going to last forever. So how long is an indwelling plastic band going to last in the patient? The answer is not forever.
Melanie: Okay. So these are reasons that you might need revision surgery after lap band. Wrap it up for us, Dr. Bell, your best advice for initial gastric bypass and/or lap band or sleeve surgery, anything that you might need the best advice for real, true weight loss.
Dr. Bell: The best advice is to really identify these maladaptive behaviors, behaviors that have promoted weight gain over the years and try to at least identify those behaviors and try to avoid those and do the opposite. In other words, if somebody is not really one for exercise, do something. Go for a walk. Get a comfortable pair of shoes. Walk around the pool if you have the means. And then, also, try to identify these types of bad eating behaviors that we’ve sort of developed as a society—eating when you’re not hungry, terrible habits, eating in front of the television, terrible habit, continuing to eat even though you’re full, cleaning one’s plate. I always say this is something mom taught us wrong is to clean your plate. It’s a terrible habit. So try to identify these habits, and don't do them even before surgery. And again, do your research about what these surgical procedures involve and what’s going to be necessary post-operatively.
Melanie: Well, thank you so much, Dr. Robert Bell, bariatric surgeon at Summit Medical Group. You’re listening to Summit Medical Group Radio. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. This is Melanie Cole. Thanks for listening.
Correcting Previous Surgical Weight Loss Procedures
Melanie Cole (Host): Patients that have previously had gastric bypass surgery, they might seek revision weight loss surgery for a few reasons. Maybe their surgery didn’t help them lose the weight that they wanted, or it just wasn’t enough to help them get past that really tough problem. My guest is Dr. Robert Bell. He’s a bariatric surgeon with Summit Medical Group. Welcome to the show, Dr. Bell. Tell us about revision surgery. Why might some people that have had gastric bypass bariatric surgery, needed to lose maybe 80 or 100 pounds, had to go back in? Because my sister had lap band over bypass, so I know something about this. Tell us why people might have to do this.
Dr. Robert Bell (Guest): Well, that’s a great question. Actually, by far, the most common revisionary surgery done today is actually lap band removal and conversion to something else. So your sister has the exact opposite thing happened, but that would be the one in 100 bariatric surgical procedures as opposed to the other 99 out of the 100 bariatric surgical procedures are actually the most common revisionary bariatric surgery is going to be lap band removal, for one reason or another. But in general terms, the most common reason to perform a revisional weight loss surgical procedure is failed weight loss. The second most common reason to perform a bariatric surgical revision would be a complication from the original procedure. When it comes to lap band, lap bands can slip. Lap bands can erode. Lap bands can have port side infections. Those are very common reasons to remove the band. Another thing that is fortunately not as common is esophageal dilatation that can occur after the introduction of a lap band. That would be another reason to have it removed. That is a complication. But even though I said all those scary things, the most common reason for lap band removal is failed weight loss. But the other weight loss surgical procedures, as you know sort of from personal experience, also may need to be revised down the line, whether it’s gastric bypass or sleeve gastrectomy. Again, the most common reason for revising a gastric bypass or sleeve gastrectomy would be for failed weight loss. The next most common reason would be for a complication of either of those operations.
Melanie: So after the surgery, and let’s start with gastric bypass. It’s a big surgery making the pouch. Now, there’s a certain compliance that goes along with after surgery. And if that compliance, the pouch, it can grow bigger again or something, as I understand it, correct? So if the compliance isn’t there, speak about why somebody might need additional surgery after that one, and then we’ll talk about the lap band.
Dr. Bell: It’s a great way that you put the question, and that is just because one is full doesn’t mean that one is not going to eat. You would think that that’s just common sense. But instead, some people -- and again, it can be cultural and it can just be years of bad habits that can creep back in. Just because you have a small stomach doesn't mean that you’re not going to out-eat. Really, the reason why bariatric surgical patients, whether it’s sleeve gastrectomy, gastric bypass—and we’ll get to lap band later—the reason why they can eat more, it really has to do with more like a grazing behavior. So they’re eating little bits of calories all day long, and it’s certainly possible that the pouch stretches a little bit. But what is far more probable is that the person, through their bad behaviors, their maladaptive behaviors, sort of trains the food to go from a very small pouch to the small intestines faster. And we all have about 20 feet of small intestines, so if you strain yourself—I’m going to use that word—to eat a little bit more, a little bit more, a little bit more, you’ll actually force the food from the very small pouch into the small intestine, and really, will enable you to eat, I don't want to say an unlimited portion, but it will enable you to eat a big portion. It’s not so much that the pouch has grown per se. It really has to do with the food emptying out of the pouch faster.
Melanie: So, if somebody does that, and so the adherence to all of those behavioral lifestyles has really not changed because they’re sort of back to eating, maybe they can’t eat as much at once, but they’re eating more throughout the day little, little, little, little, and filling up their small intestine. So then they’re not losing the weight and possibly even having some malabsorption issues, correct?
Dr. Bell: Well, they’re not going to lose the weight if they’re eating frequently throughout the day. And again, that’s a habit that needs to be addressed. So it’s very important that we talk in these terms to patients. In general, primary, meaning first-time weight loss surgery has a success rate of 80 percent, about four out of five. That’s pretty good. You take the 20 percent and then submit them to revisional surgery. Really, the success is about 50 percent, so it drops pretty significantly. The reason why it drops is because even though patients will tell everybody, they will tell me and they’ll tell the psychologist that okay, now, they’re going to change their behavior, really, only about one in two will actually make those changes, and the other one in two will continue along with those maladaptive behaviors that will put the weight on. There really is no operation for grazing behaviors, eating throughout the day and there’s no operation for people who are not going to get off the couch. So really, those behaviors need to be addressed, and we’re very serious about that when we talk to patients before revisionary surgery, talk and say, “Listen, you’ve already been through this once. You know what behaviors are good behaviors, and hopefully, you’ve learned which behaviors are bad behaviors. So it’s really important that you not just have surgery. You’re going to get 20, 30, 50 pounds off right away. Then, what are you going to do? What’s next? Are you going to eat right and exercise, you’re going to fall back into that habit?” And so you want to really make sure these patients are educated before undergoing any type of revision or any procedures.
Melanie: Well, so speak about lap band a little bit, Dr. Bell, because lap band is done laparoscopically. It’s a bit of an easier surgery, as you said previously. You can get back even into activity after a day or two, at least to start walking. So speak about lap band and why might that not kind of hold and work for somebody?
Dr. Bell: Yes. You make no mistake. The first laparoscopic gastric bypass done in 1994 was done well before the first laparoscopic gastric band. It’s just a marketing term. You know, lap band, oh, that’s done laparoscopically. All bariatric surgery procedures are done laparoscopically, or all can be done laparoscopically. And again, about 95 percent of all bariatric surgical procedures are done laparoscopically—laparoscopic gastric bypass, laparoscopic sleeve gastrectomy. So a lap band is basically placing a silastic ring around the top part of the stomach, and that ring is connected to a tube, which is connected to a reservoir that sits underneath one skin. And that reservoir needs to be accessed by way of a very, very long needle. What you can do is you can adjust the outlet from the stomach into generally the normal stomach by putting food in or out of that reservoir. So it’s an operation that has been shown -- again, statistically speaking, of course there are individuals all over the place. But statistically speaking, it has the worst weight loss of any weight loss surgery operation, and there certainly is a growing sentiment that any lap band that gets put in is ultimately going to need to come out at some point. Again, the band is made of plastic, and everybody that has a knee replacement would know that well, that titanium knee is not going to last forever. So how long is an indwelling plastic band going to last in the patient? The answer is not forever.
Melanie: Okay. So these are reasons that you might need revision surgery after lap band. Wrap it up for us, Dr. Bell, your best advice for initial gastric bypass and/or lap band or sleeve surgery, anything that you might need the best advice for real, true weight loss.
Dr. Bell: The best advice is to really identify these maladaptive behaviors, behaviors that have promoted weight gain over the years and try to at least identify those behaviors and try to avoid those and do the opposite. In other words, if somebody is not really one for exercise, do something. Go for a walk. Get a comfortable pair of shoes. Walk around the pool if you have the means. And then, also, try to identify these types of bad eating behaviors that we’ve sort of developed as a society—eating when you’re not hungry, terrible habits, eating in front of the television, terrible habit, continuing to eat even though you’re full, cleaning one’s plate. I always say this is something mom taught us wrong is to clean your plate. It’s a terrible habit. So try to identify these habits, and don't do them even before surgery. And again, do your research about what these surgical procedures involve and what’s going to be necessary post-operatively.
Melanie: Well, thank you so much, Dr. Robert Bell, bariatric surgeon at Summit Medical Group. You’re listening to Summit Medical Group Radio. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. This is Melanie Cole. Thanks for listening.