Patients who have had a weight-loss procedure in the past may encounter problems such as weight regain, or issues with not tolerating a band, for example. It is worthwhile considering whether a band may need to be removed in this situation. It is also possible to convert the procedure to a sleeve or bypass. In the situation where a band is converted to a sleeve, this is done in two separate procedures – one to remove the band, and another to perform the sleeve. The reason for this is that doing both in the one procedure has a higher risk of complications, particularly leak from the staple line. In most cases, converting a band to a bypass can be done in the single operation. The decision about which procedure to perform is based on individual circumstances, and takes into account various factors.
Revisional Surgery
– Understand the aims of the procedure and its limitations – recognize that the surgery is not a magic weight-loss solution. It is merely a tool to help you to alter your lifestyle and eating habits. You need to be committed to changing your lifestyle, knowing that the surgery will help you to do this.
– Investigations
1) Baseline blood tests will be routinely done to check the blood count, kidney and liver function
2) A gastroscopy procedure may be recommended prior to any weight-loss surgery if you have a significant history of reflux or ulcers – this may influence the type of surgery which we recommend
3) X-rays or other medical imaging scans are sometimes but not routinely done.
– Optimise your health
1) This includes seeing other specialists particularly if you suffer from other medical problems such as sleep apnoea or diabetes
2) Smoking is generally bad for people undergoing surgery. In the short-term it delays wound healing, increases the risk for infections such as pneumonia
3) It is also problematic in bariatric surgery, particularly in bypass where it leads to ulcers in the stomach which can cause pain, bleed, or even perforate
4) Medications will be reviewed and certain medications such as blood-thinners will need to be stopped beforehand
– Dietician consultation
1) The dietician will be closely involved before and after surgery to guide you along your journey
– Meal replacement – very low calorie liquid diet
1) The most commonly used product is Optifast
2) Usually taken for 2 weeks
3) The liver stores a lot of fat, so in obese patients the liver is often swollen and stiff. This can make the surgery difficult because the liver needs to be retracted up away from the stomach in order to proceed. Sometimes if the liver is too fat, the surgery can’t proceed safely. Meal replacement allows the liver a chance to shrink, and make the surgery technically easier and safer.
