What is Revision Surgery for Bariatric Patients?

Have you had gastric sleeve, or another form of bariatric surgery and it wasn’t successful? Hoping for another option? Revision surgery may be for you.

Whether or not you are a candidate for revision surgery depends on many factors, such as if you have already undergone a bariatric procedure and need to repair the first one, if you have not lost enough weight, or if you’ve gained a significant amount of weight back after surgery.

Why is Revision Surgery Important?

After making the commitment and going through one bariatric surgery, such as gastric bypass or gastric sleeve, it’s important to find out why it may not be working and what you can do to remedy the outcome. Obesity is a disease, that like many others, can take more than one treatment to find a solution.

Every person is unique with specific needs, restrictions, medical ailments, genetics, and lifestyle factors. When performing weight loss surgery, these variables can affect the outcome, as well as others that may not be known until after surgery.

Sometimes, the original bariatric procedure wasn’t the right one for the patient, or it was done incorrectly. If it was done incorrectly, it’s critical to determine what went wrong and get it taken care of to avoid major health complications and nutritional deficiencies that can ultimately result in serious illness and even death.

Am I a Candidate?

If you have followed your medical team’s recommendations, including eating a restricted diet, supplementing with bariatric-specific vitamins and minerals, including vitamin B12, calcium and iron; exercising, and attending regular follow up visits, and you still haven’t lost the desired weight, you may be a candidate for revisional surgery.

If you’ve gained back 50% of the excess weight since the first procedure or you suffer serious digestive issues like chronic ulcers that aren’t remedied with your doctor’s help, you may also qualify. Other considerations include:

• Medical problems related to obesity, such as diabetes, are diagnosed or return.
• A BMI of 40 or higher.

Whatever the reason, not losing enough weight from the start or regaining weight after bariatric surgery does not mean you did something wrong – don’t blame yourself or feel ashamed – it is common and should be addressed with your weight-loss medical team

 “The average person who undergoes gastric bypass will eventually regain 20 to 30 percent of the weight they initially lost. About a third of patients will gain back nearly all of their lost weight,” says Pichamol Jirapinyo, MD, MPH, an advanced endoscopy fellow in the Division of Gastroenterology, Hepatology and Endoscopy of the Department of Medicine at Brigham and Women’s Hospital (BWH).

Types of Revisional Surgery

Weight-loss revisional surgery offers the following possibilities for either redoing gastric bypass, gastric sleeve or band, or duodenal switch (BPD-DS), or adding another procedure to your original surgery. For instance, if you had gastric bypass, adding an adjustable gastric band (Lap band) may be the doctor’s recommendation.

• Surgical reversal, or “takedown,” of original bariatric surgery.
• Total revision of gastric bypass.
• Converting a gastric sleeve to a gastric bypass.
• Converting a gastric sleeve to a duodenal switch (BPD-DS surgery).
• Laparoscopic revision of the gastric sleeve.
• Endoscopic stoma reduction (StomaphyX) of the pouch and the connection of the upper intestine to the pouch.
• Laparoscopic distalization – moving, lengthening or shifting position of the bypass limb (section of upper intestine, jejunum), which may change the rate of food absorption.
• Laparoscopic adjustable gastric band (Lap Band or Realize band) over your existing gastric bypass. This is more easily done than restructuring the pouch itself and can be regularly adjusted in a simple in-office appointment.
• Laparoscopic revision of the gastric pouch by folding (plication) or a revision of the ‘candy cane’ (twisting) portion of the jejunal limb.

We would like to emphasize, as with most surgeries, that gastric bypass and weight-loss surgery revisions are technically challenging and can carry a high risk of complication. It is important to discuss your situation and options with your bariatric medical team and realize that there are many action steps and evaluations that must be met and/or ruled out first, before revision surgery is approved.

How Will Vitamin Supplementation Change with Revision Surgery?

Nutritional deficiencies from your original surgery may already be an issue, so it is vital to take the recommended supplements daily to avoid irreversible health damage. The most common deficiencies from bariatric and revision procedures are:

Protein Deficiency

Protein deficiency can be a problem because you can’t eat much protein due to a small stomach pouch. It is recommended that you ingest 60–80 g/day of high-protein foods (meat, eggs, and cheese) first before vegetables, fruit, or grains. Supplements should include protein powder or other liquids.

ProCare Health’s LiquaCel, a collagen and whey blend, offers a sugar-free, gluten-free one-ounce shot of 16 grams of delicious protein that can be taken straight or mixed in water. It’s hard to get enough from eating; this is a perfect food alternative and a convenient supplement that can be taken multiple times per day, at work, at home, at the gym, or out-and-about.

We also have gluten-free Whey Isolate Protein Powder with 26 grams of protein in chocolate and vanilla, a perfect addition to shakes, smoothies, and even coffee. ProCal Unflavored Whey Protein is also available with 5 grams of protein, allowing you to boost the protein content of oatmeal, shakes, yogurt, and more.

Calcium Deficiency

Calcium deficiency occurs because the primary absorption organs (duodenum and proximal jejunum) are typically “bypassed” and most calcium-rich foods are harder to digest. Brittle nails, muscle cramps, delusions, depression, insomnia, irritability, osteoporosis and soft bones are but a few symptoms. Supplementation should include 1000–1200 mg of calcium citrate, as calcium carbonate is not easily absorbed.

If you choose ProCare Health’s calcium soft chews with Trucal®, you get an all-natural, lactose-free calcium with higher absorption than that of plain calcium citrate. Unlike other calcium forms, Trucal also offers other essential minerals and antioxidants, like iron and sodium, and each chocolate bar has 500 mg calcium plus 500 IU’s of Vitamin D. Two-a-day makes for a delicious after-meal treat or a pick-me-up when cravings strike.

Iron Deficiency

Iron deficiency is also called “anemia,” is very common for two reasons: less gastric stomach acid is available and the primary organs that absorb iron – the duodenum and proximal jejunum – may be bypassed. Menstruating females are even more susceptible to anemia for obvious reasons. It’s difficult to get enough iron from food since the amount of dietary red meat is reduced and consumption is poorly tolerated by some patients.

If blood work shows you have an iron deficiency, it’s important to take iron sulfate with vitamin C for increased absorption. ProCare Health has a once-daily capsule or chewable Bariatric Multivitamin with 45 mg of iron and 130 mg of Vitamin C for easy absorption.

Vitamin B12

Vitamin B12 is a very prevalent deficiency, even in the general population. It is critical for every cellular function and can lead to many different consequences when insufficient. In bariatric patients, due to the small stomach pouch created by the surgeon, low intake of food rich in vitamin B12 – mainly meat and protein sources – becomes problematic.

It is recommended that you supplement your diet with B12 in an easily-absorbed form like a liquid or sublingual dissolvable tablet. ProCare Health has the most absorbable form of B12 (methylcobalamin) in our once-daily capsule and chewable Bariatric Multivitamin for maximum effectiveness.

ProCare Health’s selection of protein, vitamins and minerals, and supplements are all designed to make this part of your journey easier. They are formulated to give you the balance you need in fewer supplements to avoid common nutritional deficiencies like anemia, osteoporosis, poor immunity, heart issues, cognitive issues, and more.

How Will Vitamin Supplementation Change with Revision Surgery?