Skip to main content

Advertisement

SpringerLink
Log in

Revisional bariatric surgery for inadequate weight loss

  • Review
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

When behavioral or anatomic issues are not present, revisional surgery should be approached with a goal of treating malnutrition or enhancing excess weight loss. Unfortunately, no randomized controlled trials currently exist to help the practicing bariatric surgeon choose which revisional procedure to perform. A review of the available literature was undertaken and compared with our standard practices to see if any guidelines could be devised. At our institution, patients who have failed jejunal-ileal bypass are reversed in the setting of malnutrition and converted to a sleeve gastrectomy (SG) followed by duodenal switch (DS) as a second stage procedure in the setting of inadequate weight loss. After failed vertical banded gastroplasty (VBG), patients are converted to a Roux-en-Y gastric bypass (RYGBP). After failed adjustable gastric band (AGB) placement, we perform RYGBP. In the super-obese, we leave the band in place or convert to a DS with band removal. In patients with failed RYGBP, we convert our patients to DS, but placement of an AGB may be an acceptable option.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ballantyne GH, Gumbs A, Modlin IM. Changes in insulin resistance following bariatric surgery and the adipoinsular axis: role of the adipocytokines, leptin, adiponectin and resistin. Obes Surg 2005; 15: 692–9.

    Article  PubMed  Google Scholar 

  2. Gumbs AA, Modlin IM, Ballantyne GH. Changes in insulin resistance following bariatric surgery: role of caloric restriction and weight loss. Obes Surg 2005; 15: 462–73.

    Article  PubMed  Google Scholar 

  3. O’Brien P, Brown W, Dixon J. Revisional surgery for morbid obesity — conversion to the Lap-Band system. Obes Surg 2000; 10: 557–63.

    Article  PubMed  Google Scholar 

  4. Rutledge R. Similarity of Magenstrasse-and-Mill and minigastric bypass. Obes Surg 2003; 13: 318.

    Article  PubMed  Google Scholar 

  5. Johnston D, Dachtler J, Sue-Ling HM et al. The Magenstrasse and Mill operation for morbid obesity. Obes Surg 2003; 13: 10–6.

    Article  PubMed  Google Scholar 

  6. Carmichael AR, Sue-Ling HM, Johnston D. Quality of life after the Magenstrasse and Mill procedure for morbid obesity. Obes Surg 2001; 11: 708–15.

    Article  PubMed  CAS  Google Scholar 

  7. Christou N, Look D, Maclean L. Weight gain after short-and long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg 2006; 244: 734–40.

    Article  PubMed  Google Scholar 

  8. Requarth JA, Burchard KW, Colacchio TA et al. Long-term morbidity following jejunoileal bypass. The continuing potential need for surgical reversal. Arch Surg 1995; 130: 318–25.

    PubMed  CAS  Google Scholar 

  9. Lowell JA, Shenoy S, Ghalib R et al. Liver transplantation after jejunoileal bypass for morbid obesity. J Am Coll Surg 1997; 185: 123–7.

    PubMed  CAS  Google Scholar 

  10. Deitel M, Shahi B, Anand PK et al. Long-term outcome in a series of jejunoileal bypass patients. Obes Surg 1993; 3: 247–52.

    Article  PubMed  Google Scholar 

  11. Gagner M, Gentileschi P, de Csepel J et al. Laparoscopic reoperative bariatric surgery: experience from 27 consecutive patients. Obes Surg 2002; 12: 254–60.

    Article  PubMed  Google Scholar 

  12. Gonzalez R, Gallagher SF, Haines K et al. Operative technique for converting a failed vertical banded gastroplasty to Roux-en-Y gastric bypass. J Am Coll Surg 2005; 201: 366–74.

    Article  PubMed  Google Scholar 

  13. Cariani S, Nottola D, Grani S et al. Complications after gastroplasty and gastric bypass as a primary operation and as a reoperation. Obes Surg 2001; 11: 487–90.

    Article  PubMed  CAS  Google Scholar 

  14. van Gemert WG, van Wersch MM, Greve JW et al. Revisional surgery after failed vertical banded gastroplasty: restoration of vertical banded gastroplasty or conversion to gastric bypass. Obes Surg 1998; 8: 21–8.

    Article  PubMed  Google Scholar 

  15. Gavert N, Szold A, Abu-Abeid S. Laparoscopic revisional surgery for life-threatening stenosis following vertical banded gastroplasty, together with placement of an adjustable gastric band. Obes Surg 2003; 13: 399–403.

    Article  PubMed  Google Scholar 

  16. Gavert N, Szold A, Abu-Abeid S. Safety and feasibility of revisional laparoscopic surgery for morbid obesity: conversion of open silastic vertical banded gastroplasty to laparoscopic adjustable gastric banding. Surg Endosc 2004; 18: 203–6.

    Article  PubMed  CAS  Google Scholar 

  17. Taskin M, Zengin K, Unal E et al. Conversion of failed vertical banded gastroplasty to open adjustable gastric banding. Obes Surg 2001; 11: 731–4.

    Article  PubMed  CAS  Google Scholar 

  18. van Wageningen B, Berends FJ, Van Ramshorst B et al. Revision of failed laparoscopic adjustable gastric banding to Roux-en-Y gastric bypass. Obes Surg 2006; 16: 137–41.

    Article  PubMed  Google Scholar 

  19. Cohen R, Pinheiro JS, Correa JL et al. Laparoscopic revisional bariatric surgery: myths and facts. Surg Endosc 2005; 19: 822–5.

    Article  PubMed  CAS  Google Scholar 

  20. Mognol P, Chosidow D, Marmuse JP. Laparoscopic conversion of laparoscopic gastric banding to Roux-en-Y gastric bypass: a review of 70 patients. Obes Surg 2004; 14: 1349–53.

    Article  PubMed  Google Scholar 

  21. Abu-Abeid S, Bar Zohar D, Sagie B et al. Treatment of intragastric band migration following laparoscopic banding: safety and feasibility of simultaneous laparoscopic band removal and replacement. Obes Surg 2005; 15: 849–52.

    Article  PubMed  Google Scholar 

  22. Keidar A, Carmon E, Szold A et al. Port complications following laparoscopic adjustable gastric banding for morbid obesity. Obes Surg 2005; 15: 361–5.

    Article  PubMed  Google Scholar 

  23. Peterli R, Donadini A, Peters T et al. Re-operations following laparoscopic adjustable gastric banding. Obes Surg 2002; 12: 851–6.

    Article  PubMed  Google Scholar 

  24. Weber M, Muller MK, Michel JM et al. Laparoscopic Roux-en-Y gastric bypass, but not rebanding, should be proposed as rescue procedure for patients with failed laparoscopic gastric banding. Ann Surg 2003; 238: 827–33; discussion 833–4.

    Article  PubMed  Google Scholar 

  25. Gumbs A, Duffy A, Bell R. Marginal ulceration after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2006; 2: 460–3.

    Article  PubMed  Google Scholar 

  26. Gumbs A, Duffy A, Bell R. Management of gastrogastric fistula after laparoscopic Roux-Y gastric bypass. Surg Obes Relat Dis 2006; 2: 117–21.

    Article  PubMed  Google Scholar 

  27. Bessler M, Daud A, DiGiorgi MF. Adjustable gastric banding as a revisional bariatric procedure after failed gastric bypass. Obes Surg 2005; 15: 1443–8.

    Article  PubMed  Google Scholar 

  28. Owens BM, Owens ML, Hill CW. Effect of revisional bariatric surgery on weight loss and frequency of complications. Obes Surg 1996; 6: 479–84.

    Article  PubMed  Google Scholar 

  29. Buchwald H. Bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. J Am Coll Surg 2005; 200: 593–604.

    Article  PubMed  Google Scholar 

  30. Benotti PN, Forse RA. Safety and long-term efficacy of revisional surgery in severe obesity. Am J Surg 1996; 172: 232–5.

    Article  PubMed  CAS  Google Scholar 

  31. Jones KB Jr. Revisional bariatric surgery — safe and effective. Obes Surg 2001; 11: 183–9.

    Article  PubMed  Google Scholar 

  32. de Csepel J, Burpee S, Jossart G et al. Laparoscopic biliopancreatic diversion with a duodenal switch for morbid obesity: a feasibility study in pigs. J Laparoendosc Adv Surg Tech A 2001; 11: 79–83.

    Article  PubMed  Google Scholar 

  33. Ren CJ, Patterson E, Gagner M. Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg 2000; 10: 514–23; discussion 524.

    Article  PubMed  CAS  Google Scholar 

  34. Marceau P, Hould FS, Simard S et al. Biliopancreatic diversion with duodenal switch. World J Surg 1998; 22: 947–54.

    Article  PubMed  CAS  Google Scholar 

  35. Schouten R, van Dielen FM, Greve JW. Re-operation after laparoscopic adjustable gastric banding leads to a further decrease in BMI and obesity-related co-morbidities: results in 33 patients. Obes Surg 2006; 16: 821–8.

    Article  PubMed  CAS  Google Scholar 

  36. Keshishian A, Zahriya K, Hartoonian T. Duodenal switch is a safe operation for patients who have failed other bariatric operations. Obes Surg 2004; 14: 1187–92.

    Article  PubMed  Google Scholar 

  37. Sugerman H, Wolper J. Failed gastroplasty for morbid obesity. Revised gastroplasty versus Roux-Y gastric bypass. Am J Surg 1984; 148: 331–6.

    Article  PubMed  CAS  Google Scholar 

  38. Reinhold RB. Critical analysis of long term weight loss following gastric bypass. Surg Gynecol Obstet 1982; 155: 385–94.

    PubMed  CAS  Google Scholar 

  39. Kyzer S, Raziel A, Landau O. Use of adjustable silicone gastric banding for revision of failed gastric bariatric operations. Obes Surg 2001; 11: 66–9.

    Article  PubMed  CAS  Google Scholar 

  40. Calmes J, Giusti V, Suter M. Reoperative laparoscopic Roux-en-Y gastric bypass: an experience with 49 cases. Obes Surg 2005; 15: 316–22.

    Article  PubMed  CAS  Google Scholar 

  41. Khaitan L, Van Sickle K, Gonzalez R et al. Laparoscopic revision of bariatric procedures: is it feasible? Am Surg 2005; 71: 6–10; discussion 10–2.

    PubMed  Google Scholar 

  42. Nguyen NT, Longoria M, Gelfand DV et al. Staged laparoscopic Roux-en-Y: a novel two-stage bariatric operation as an alternative in the super-obese with massively enlarged liver. Obes Surg 2005; 15: 1077–81.

    Article  PubMed  Google Scholar 

  43. Mognol P, Chosidow D, Marmuse JP. Laparoscopic sleeve gastrectomy as an initial bariatric operation for high-risk patients: initial results in 10 patients. Obes Surg 2005; 15: 1030–3.

    Article  PubMed  Google Scholar 

  44. Gagner M, Boza C. Laparoscopic duodenal switch for morbid obesity. Expert Rev Med Devices 2006; 3: 105–12.

    Article  PubMed  Google Scholar 

  45. Yashkov YI, Oppel TA, Shishlo LA et al. Improvement of weight loss and metabolic effects of vertical banded gastroplasty by an added duodenal switch procedure. Obes Surg 2001; 11: 635–9.

    Article  PubMed  CAS  Google Scholar 

  46. de Csepel J, Quinn T, Pomp A et al. Conversion to a laparoscopic biliopancreatic diversion with a duodenal switch for failed laparoscopic adjustable silicone gastric banding. J Laparoendosc Adv Surg Tech A 2002; 12: 237–40.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. New York-Presbyterian Hospital, Division of Laparoscopy and Department of Surgery, Weill-Cornell College of Medicine, New York, NY, USA

    Andrew A. Gumbs MD, Alfons Pomp MD & Michel Gagner MD (Chief)

Authors
  1. Andrew A. Gumbs MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alfons Pomp MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michel Gagner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michel Gagner MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gumbs, A.A., Pomp, A. & Gagner, M. Revisional bariatric surgery for inadequate weight loss. OBES SURG 17, 1137–1145 (2007). https://doi.org/10.1007/s11695-007-9209-9

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-007-9209-9

Key words

Search

Navigation