What to Do When Bariatric Surgery Doesn’t Work for You

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What happens when a patient loses weight after a bariatric procedure only to gain it back? Is there hope after bariatric surgery that didn’t work?

John Paul Gonzalvo, DO, FACS, bariatric surgeon at the AdventHealth Bariatric Surgery at Tampa, says that about 4 out of 5 times when weight loss surgery fails, it’s because the patient went back to his or her old way of eating. However, in the other cases, it is because something went wrong with the bariatric procedure itself.

“Revision surgery for bariatric procedures is becoming more common,” says Dr. Gonzalvo. According to the American Society for Metabolic and Bariatric Surgery (ASMBS), in 2018 there were about 252,000 bariatric revision surgeries in the U.S. compared to about 15,000 in the mid-1990s. Revision surgery involves redoing a bariatric procedure to correct a physical problem with it.

Restoring a Bariatric Procedure So It Will Work Again

In some situations, the bariatric procedure went wrong because it was never an ideal approach to begin with. This has often been the case with the LAP-BAND procedure. The LAP-BAND only limited the amount of food a patient could eat, but it had little effect on hormones to make a person want to eat less and consume healthier foods. In this case, surgeons at Bariatric Surgery at Tampa can remove the LAP-BAND and perform a new bariatric procedure such as a sleeve gastrectomy or a gastric bypass. This approach is called a “conversion” because the surgeon converts the LAP-BAND into another bariatric procedure.

“Different procedures need different corrections,” Dr. Gonzalvo explains. “Sometimes the stomach pouch has become enlarged, or, in the case of a gastric bypass, food is going through the stomach the old way.”

Dr. Gonzalvo says that while patients who previously had a gastric bypass cannot have another one, he and his colleagues can offer these patients surgery that makes the stomach pouch smaller again. Creating a smaller stomach pouch is also an option for patients who had previous bariatric procedures but didn’t stick to the right diet.

Revision Surgery Won’t Fix a Diet Problem

While the surgeons at Bariatric Surgery at Tampa correct many bariatric procedures that have developed issues, Dr. Gonzalvo is quick to point out that more surgery won’t change a patient’s diet problems.

“You have to earn a revision,” he says, noting that he usually requires his patients to lose 30 to 40 pounds before their procedures to prove they have the ability to keep eating healthy for the rest of their lives.

Dr. Gonzalvo doesn’t fault patients for their past diet failures. He states, “Twenty years ago when gastric bypasses were common, there was also poor education about diet.” Patients now often need help to get their diets on track, something Bariatric Surgery at Tampa offers through its friendly and encouraging dietitians.

Setting Expectations for What the Bariatric Surgery Revision Can Accomplish

“Weight loss is never as dramatic after a revision,” says Dr. Gonzalvo. He adds that initial bariatric surgery changes a patient’s hormones that influence appetite and fat storage in ways that cannot fully be benefited from again when a patient regains weight.

If patients can lose up to 75 percent of their excess weight after their initial bypass procedures, a revision may enable them to lose only up to 35 percent of that weight. However, that lost weight still may be significant and improve a person’s lifestyle.

Bariatric Surgery at Tampa: A Regional Hotspot for Revision Surgery

Dr. Gonzalvo and his colleagues, John A. Dietrick, MD, FACS and Michel Murr, MD, FACS, are some of the only bariatric surgeons in the area willing to fix patients’ bariatric procedures.

“Revisions are an involved operation. They take twice as long as the initial bariatric procedure, and are more complicated,” Dr. Gonzalvo says. He adds that because prior surgery was performed in the same area, patients go into the revision operation with tissues already scarred, which makes it more difficult for surgeons to work with.

Even so, the bariatric surgeons at Bariatric Surgery at Tampa complete revision procedures well. They are experienced in performing them safely, and have low rates of complication and high rates of success. They are happy to help patients get back on track to better health.

If you have had a bariatric procedure but regained weight and are interested in knowing more about bariatric revision surgery, meet with a surgeon at the AdventHealth Bariatric Surgery at Tampa. To schedule a telemedicine or in-person consultation, call Call813-971-2470.

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