Bariatric revision surgery Perth

Phil had a successful revision surgery.

Revision surgery Perth

Revision
Surgery

Sometimes bariatric surgery doesn’t work. Or, it works really well initially, and then later you find yourself putting weight back on. Or, sometimes people just don’t lose enough weight after their surgery. These things do happen, and then, the question is what to do. In these cases, revision surgery might be the right choice for you.

Is revision surgery without risks?

Revision surgery is difficult and the risks associated do increase, so it is not a decision to be taken lightly. We believe the decision to pursue further weight loss surgery should be considered carefully.

What is Revision Surgery?

Revision surgery is when a further operation is required to achieve your weight loss goals. Our specialists will talk to you about the different options we can offer you.

These may include a new start programme to break through bad habits, boredom, or stress eating. Medication may be recommended to help to get you back on track. Sometimes, you may need further bariatric revision surgery.

In our Perth clinic, you get to make the decision about what feels like the right option for you. First, you will be given all the facts by our experts who have extensive experience in the field of bariatric surgery and weight loss management. Remember, nothing is ever written in stone. We can always revisit the options, and it’s perfectly OK to change your mind.

If you feel like you would like to review your options again or discuss things further with our specialists, we are more than happy to do this.


Why are these operations sometimes unsuccessful?

Why do people not respond as well to surgery as we would like? Well, there are several issues to discuss:

You must remember that your body wants to be a certain weight (called the “Set Point”) and will do sneaky things to make you put weight back on;

There is a natural tendency for people to gain weight with time, usually related to your metabolism slowing down;

People can have bad eating habits such as eating the wrong foods or “grazing”. Don’t forget that “stress eating” or “boredom eating” is a very real thing. Breaking these habits can be really difficult;

Pregnancy causes weight gain, and it causes our surgery to stretch;

Medications can make you put on weight. Talk to us about weight friendly medication options;

Some people do respond more poorly to weight loss surgery. The actual response rate to surgery is determined by your genetic makeup. For example, twins respond to surgery in almost an identical way, siblings are very similar, and cousins less so. If someone in your family has done badly with surgery, your results may also be not as good. Your surgeon may need to be a little bit more aggressive with your surgery than normal;

Having a gastric band inserted previously will reduce the effectiveness of your revisional surgery because:

  • they cause scarring which can impact the surgeon's ability to perform revisional bariatric surgery;
  • they cause oesophageal stretch that sabotages the restrictive component of bariatric surgery and;
  • the band facilitates/promotes bad eating habits such as grazing and eating softer/calorie-dense foods;

Surgery done badly never works, if your sleeve is made too big or your bypass too short, it may work a little initially, but then you may fall short of your target weight loss.

Video: Why do some weight loss operations not work? | Perth bariatric surgeons

How do you revise a (Roux-en-Y) gastric bypass?

A gastric bypass revision is difficult. The recommendation is to asses the bypass with radiological tests, then do an endoscopy to get a feel for the size of the stomach pouch and the size of the anastomosis.

If the pouch has stretched, then it could be reduced and a Minimiser Ring placed to prevent it from stretching again. If the anastomosis has stretched it can be tightened or revised.

If both of these things are normal, then it is advised to reduce the length of the common channel so the total distance from the gastric pouch to the colon is 3.5 metres. This will introduce a significant malabsorptive element to the operation. Like a duodenal switch, this will cause significant diarrhoea and flatulence.

The operation can always be undone, if needed, in situations where these symptoms are not tolerable. The symptoms do improve with time, but we don’t expect them to ever resolve completely. It takes about a year for a significant improvement of symptoms.

revision surgery Perth

How do you revise a gastric sleeve?

There are a few options for a gastric sleeve revision. In order to choose the right option for you, it is important to know the reason/s why the revision surgery is required. Commonly, our patients will have their sleeves revised as a result of either weight gain or reflux symptoms.

First, an endoscopy is needed to get a feeling for what the sleeve looks like, and to determine the extent of gastric reflux. Based on this information, we can consider which approach will be suitable.

The options that we offer clients in our clinic include the following:

Re-sleeve

Our bariatric surgeon may decide to perform a re-do of the Sleeve and tighten it back down. Over a sizing bougie, we can excise any part of the stomach sleeve that has stretched or that was missed the first time around. This option will help with weight loss by reducing the amount you can eat, but will not help with reflux. Fixing a hiatus hernia style defect may improve the reflux symptoms but the effectiveness is variable.

RNY Gastric Bypass

This is a great revision option for reflux symptom control, however there is minimal additional weight loss provided by this option. We find that the weight loss with a RNY Gastric Bypass and a Sleeve are quite similar, so it’s not surprising that changing from one to the other doesn't add much from a weight loss point of view.

Omega Loop Gastric Bypass

This is another great revision option with a strong success rate. It is good (though not great) for reflux symptom control, and is more aggressive for weight loss than a RNY Gastric Bypass. We see good weight loss with this conversion option. However, it will cause “dumping” if you eat sugary foods, resulting in malabsorption. This means that the blood levels of elemental vitamins MUST be monitored very carefully.

SADI

SADI is also a good revision option. It requires the sleeve component to be snug and small to work well. This particular type of weight loss surgery will make no difference to reflux symptoms, and it leads to a moderate degree of nutrient malabsorption which results in significant diarrhoea. Vitamins must be replaced and monitored carefully.

What options are there to revise a Gastric Band?

There are a lot of individuals with gastric bands in our community. Our feeling is that they will all need revising eventually. The band is designed to stay in forever, but we are seeing cases where the silicone has degraded or is damaged, the contained saline starts leaking, and the band loosens. Subsequently, the band loses effectiveness.

gastric band revision Perth

The first step is to take the band out and remove all the tunneling stitches holding it in place. This gives us a good chance to examine your stomach and intestines and make a comment on your suitability for a subsequent operation.

We like to wait three months before performing the second operation to allow the scarring to soften. It is possible to do the operation all in one step, but the risk of having a leak is higher. I also worry that the size of the stomach pouch or sleeve will not be as tight. This would compromise the long term outcome.

Revision options we offer in our Perth bariatric clinic:

SLEEVE GASTRECTOMY

Sleeve gastrectomy will give you the restriction of a band, but without the vomiting or food getting stuck. It doesn’t involve any malabsorption, so vitamin deficiency is much less of an issue.

(RNY) GASTRIC BYPASS

Roux-en-Y gastric bypass is great for reflux control, and good weight loss is achievable.

OMEGA LOOP GASTRIC BYPASS

An omega loop gastric bypass is a better option for weight loss, and not too bad for reflux control.

ANOTHER GASTRIC BAND

Some people love bands and, if your band is not working, many weight loss surgeons will offer another gastric band. We generally discourage this because we feel that we can provide you with a better option for achieving your weight loss goals. However, if you love your band we are more than happy to do this for you. It’s important to remember to expect the same issues with your new band as the old one, such as food getting stuck and vomiting. The new band has the same risks as the first band of slipping or eroding into the stomach.

Serious About Surgery

The team at Obesity Surgery WA would like you to know that we are serious about surgery, and about achieving the best outcome for you. The decision to proceed to surgery should never be taken lightly. The benefits are great, even amazing, but each procedure carries potential complications. The risks and benefits of every step must be carefully considered.

We are more than happy to guide you through this journey and provide as much information as you require. We want you to have the best support and risk management, with attention to every detail, so you can achieve your healthy weight. Ultimately, we know that the final decision is always yours.

About Obesity Surgery WA: Our 6 commitments

Taking surgery seriously

We know that entering into an operation is a big deal and we are very serious in getting the best outcome for you. We practice what is considered to be a world class standard. Our staff regularly attend national and international conferences and bring back what is the latest research and technology.

Running on time

Our Surgeons and all of our staff try their best to run on time. Although it's not always possible, our commitment is that we do our best. Your time is valuable and we respect that.

Readily available

Our surgeons (or at least one of them) are always available in a crisis. Some of them may provide you with a direct contact, but all are available through the hospital switchboard and happy to chat any time if there is a crisis.

An obsessive attention to detail

We do our best to not miss anything. Every stitch, every staple and every clip is applied to exactly where it needs to be with the greatest care possible.

Commitment to performing the best operation possible

Not all operations are the same and there a few extras that we do to make things better. We know that our results are better with the minimiser ring so we offer it to everyone. We know that reflux can be an issue so we try to tighten every oesophageal hiatus to make reflux control as good as possibly can be.

A commitment to new technologies

  • We have brought in STRETTA into Western Australia, which we believe will revolutionise reflux management. (Have a look at the Stretta page for more information).

  • SJOG Murdoch has just purchased a new DaVinci robot and we believe that this will allow us to do operations with keyhole surgery that previously needed a major laparotomy incision. Lynx is on the horizon and promises to also help manage reflux, we hope to have access to this in early 2020.

Useful links

Gastric
sleeve

Laparoscopic Sleeve Gastrectomy is the most common bariatric operation performed in Australia to achieve weight loss. In the right hands, a well-constructed sleeve gastrectomy is a powerful and safe weight loss tool.
Gastric sleeve

Gastric
bypass

Of all bariatric surgeries available, gastric bypass is probably the most well known. The newer version of the surgery is even more effective, and both bypasses are especially good as a revision surgery after a previous weight loss surgery.
Gastric bypass

About

Obesity Surgery WA is lead by Dr Harsha Chandraratna. After graduating at UWA, Harsha began his surgical training and was made a Fellow of the Royal Australasian College of Surgeons in 2001. Dr Chandraratna understands the impact of obesity. He personally had sleeve gastrectomy surgery, which gives him a really deep level of understanding when he works with his patients on a daily basis.

About us

Meet our team

Dr. Harsha Chandraratna

Dr. Harsha Chandraratna

Consultant Surgeon
MBBS FRACS

Harsha was made a Fellow of the Royal Australasian College of Surgeons in 2001. He undertook post fellowship training in Perth and then in Leeds (UK) in Liver and Kidney Transplantation as well as Bariatric Surgery. He understands that there is more to surgery than just technical skills and hopefully that will become apparent to you when you meet him.
Dr Andrew Kiyingi

Dr Andrew Kiyingi

Bariatric & General Surgeon
MBChB, PGDipSurgAnat, FRACS

Andrew Kiyingi is a weight loss and general surgeon. Andrew completed his surgical training at St Vincents Hospital in Melbourne and was awarded Fellowship under the Royal Australian College of Surgeons in 2014. Andrew has since undertaken 3 years of advanced sub-specialist training in bariatric and minimally invasive surgery.
Dr. Bill Gong

Dr. Bill Gong

General and Laparoscopic Surgeon
MBBS FRACS

Bill Gong is a specialist General Surgeon. He completed his training at The Alfred Hospital in Melbourne and obtained his Fellowship with the Royal Australasian College of Surgeons in 2014. In 2016, Dr Gong commenced private practice at St. John of God Hospital, joining Associate Professor Harsha Chandraratna.