Overview of Gastric Bypass Revision with LAP-BAND
Sometimes, gastric bypass patients do not achieve their weight loss goals. As disappointing as this situation is to the individual, it does not need to be the end of the weight loss journey. In these circumstances, gastric bypass patients who are determined to reach a healthy weight may be able to revise to the LAP-BAND for additional help in losing the excess weight.
Obesity is a difficult disease to treat. Individuals who are truly committed to reaching a healthy weight should not feel like they have failed with gastric bypass surgery if their amount of weight loss is not as much as expected. If a patient had another disease, such as cancer, he or she would try every treatment option available until the disease was under control. The same may be necessary with obesity. The only failure is in giving up on weight loss, not in pursuing additional treatment options.
Weight loss following gastric bypass surgery is very rapid in the first 6 to 12 months, then begins to level out after 18 to 24 months. Some gastric bypass patients reach their weight loss goals in this time, but some do not. For other gastric bypass patients, they may have lost an adequate amount of weight initially but regain weight over time. In either case, a revision with lap band surgery can help individuals get back on track with their weight loss.
Weight loss with gastric bypass surgery often falters when either the opening from the stomach to the small intestine enlarges or the stomach pouch stretches. While it may be possible for a surgeon to operate and fix these problems, in many cases it is simpler, safer, and more effective to install a lap band to fix the problems. Once the lap band is in place, it controls the size of the stomach opening and reduces the size of the stomach pouch. It is adjustable without additional surgery to change the size of the stomach opening for a greater or lesser rate of weight loss.
LAP BAND Surgery
The LAP BAND is a restrictive form of weight loss surgery - it restricts the amount of food that can be consumed. By reducing the size of the stomach pouch (that stretched out after gastric bypass surgery), a person will only be able to eat a small amount of food at any one time and will feel full sooner. By restricting the size of the stomach opening, the band will slow down the movement of food from the stomach pouch to the small intestine which helps a person feel full for a longer amount of time. Overall, the LAP-BAND will once again help the gastric bypass patient eat less and thus continue to lose weight.
Many bariatric surgeons are revising more and more patients from gastric bypass surgery to the LAP BAND with great results. However, weight loss still depends on making healthy eating choices and engaging in daily exercise. The LAP BAND will help control how much food a person eats, but it is up to the individual to choose what food is eaten. The weight loss diet should continue to focus on low-calorie and low-fat foods. Sweets, fats, and other high-calorie foods and drinks should be removed from the diet. Remember your surgeon wants you to succeed with weight loss just as much as you do and will be willing to help you work out a nutritious diet plan. Many bariatric programs include nutritional counseling as part of their program and every patient should take advantage of this opportunity.
Revision Bariatric Surgery
Revision bariatric surgery is a bariatric procedure performed after the initial weight loss surgery. Revision surgery is not a new concept, but it is becoming more common as the overall number of initial weight loss procedures is increasing. Revision surgery is often riskier than the initial procedure, thus it is important to choose a bariatric surgeon who is experienced in revision surgery. Revision surgery may be necessary for patients who have had complications with their weight loss surgery or for patients who have had unsatisfactory weight loss. A bariatric surgeon will evaluate the patient to determine the cause of failure and to discuss the various options.
After evaluating the patient, a bariatric surgeon will make a recommendation for treatment. For some patients, a surgeon may determine that the best option is to try and re-do the original gastric bypass procedure. This option, however, may only be a temporary fix. If the procedure is being considered because the stomach pouch or stomach opening stretched, it will probably stretch again. In this case, a better option may be to revise to lap band surgery to help control eating. A second gastric bypass operation may also be riskier because of scar tissue that formed after the initial operation. For some patients, revision surgery may not be recommended, rather the patient will be asked to make a more committed approach to diet and exercise.
Reasons for Gastric Bypass Failure
- Stomach pouch stretches - over time patients tend to eat more food or eat more frequently
- Stomach opening expands - thus food empties into the small intestine at a faster rate
- Small intestine starts to work more efficiently - as the body adapts to the gastric bypass the small intestine absorbs more calories and nutrients
- Complications, such as ulcers
- Poor technique - more serious surgical complications occur in a bariatric surgeon's first 75 procedures due to lack of experience and training
- Patient failure to comply with necessary lifestyle changes - diet and exercise
Preliminary studies on patients who have revised to adjustable gastric banding (lap band surgery) after a failed Roux-en-Y gastric bypass have shown positive results. Patients with poor weight loss outcomes after RNY gastric bypass were able to lose a significant amount of excess weight with the addition of an adjustable gastric band. As a revisional approach, lap band surgery is also advantageous because it does not involve cutting the stomach or small intestine or changing absorption. Patients who are committed to achieving a healthy weight can experience significant weight loss by revising the gastric bypass to an adjustable gastric band.