Revision Bariatric Surgery Houston
Dr. Snyder performs revision bariatric surgery in Houston, Texas and revision bariatric surgery in Cypress, Texas. The most common revision operations performed are banded gastroplasty to sleeve gastrectomy or gastric bypass. In the 1980’s many fixed band were placed in the form of Molina bands or the silastic bands placed during a vertical banded gastroplasty (VBG). Both of these operations worked well for their time, and patients lost about 50% of their excessive weight. However, nearly half the patients experienced a complication from them, most commonly nausea, vomiting, and trouble eating. Because they weren’t adjustable, many of these patients had to have the bands removed, or they just learned to live with the problems.
When the adjustable gastric band became approved by the FDA in 1991, it became a very popular operation because it was relatively safe, easy to do, was an outpatient surgery, and it could be made tighter or looser depending on the patient’s need or desire. Patients had about a 40% excessive weight loss, and fixed bands fell away from popularity. Now, almost 25 years later, nearly 60% of patients are very satisfied with their adjustable banded gastroplasty, but nearly 40% at ten years are having the band removed for one reason or another. The reasons vary, but the most common reasons that I see are inadequate weight loss, trouble eating, esophageal dilation and/or reflux, or mechanical problems (like erosion or slippage).
As a result, many of these bands need to be removed, and are usually converted to another bariatric operation at the same time or in a staged procedure. Evidence has shown that 90% of patients who have lost weight with the band will regain the weight if another operation is not done after removing the gastric band. Since nothing is cut with the fixed or adjustable gastric bands, the stomach is left in relatively normal anatomy. However, this does not mean it is as easy as primary weight loss operations. I have performed hundreds of revisions of bands to sleeve gastrectomy or gastric bypass in Houston Medical Center.
They can be done safely, but your surgeon must have a large experience with these reoperations because of the scaring the bands can leave behind. The literature quotes that revision operations have a 10 fold increase in complication rates. My complication rates for revision operations are less than 2% compared to 15% national average. I attribute that to the good use of robotic technology that allows me to see and manipulate tissue in a more exact and precise fashion. I also contribute this to a good understanding and knowledge of bariatric surgery. For instance, many fixed bands can be removed through and erosion technique developed by myself and other surgeons at the University of Texas. This allows us to remove the bands without incisions or operations on the abdominal cavity. Once the band is removed, we can then procedure with the revision to another operation without worry about the band in our way.
Other revisions that I have commonly performed in Texas are revision of sleeves to make them smaller or convert them to gastric bypass. This may be done if the patient has not lost enough weight or they are experiencing significant reflux after the sleeve gastrectomy. I have also revised many gastric bypasses to make the pouch smaller, revise the opening between the pouch and the bowel, or lengthen the amount of malabsorption. This may need to be done if the patient has regained weight or has an ulcer in the pouch, for example.
Essentially, there is no bariatric operation that cannot be revised. It requires a conversation with your surgeon so they can understand what you have had done a work up to examine the anatomy of the previous operation, and then good execution to restore normal anatomy and convert that to a new bariatric operation that will work. Since I began doing revision bariatric surgery five years ago, I have done hundreds of them. I am confident I can help you if you need a revision. Let my Medical Center experience serve you with Private Practice Service.
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