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Jul24
REVISION OF Roux en Y GASTRIC BYPASS
When patients who had weight loss surgery in the past require other procedures to correct the complications or undo the ill effects of their original operation, it is called a revisional weight loss surgical procedure.The clients who seek revisional surgery may have lost their weight only to gain it back or some may have had inadequate weight loss. There are also those patients that had ill effects of their primary operations including ulceration and stricture, in the case of Roux en Y gastric bypass, and slippage and erosion , in case of adjustable gastric banding.There are some patients who have been able to lose the weight and keep it off; however, this comes at the cost of a near constant nausea and frequent vomiting.The failure of the primary surgery is frequently blamed on the patient, however that is usually not the case. A less than ideal outcome of a weight loss surgical procedure can be traced back to a procedure that did not work for that particular patient. Its just like trying a number of blood pressure medications to find the one that works best for them. Alternatively, the procedure may have delivered the best outcome possible which may be inadequate for that particular patient or the condition. Conditions that require revisional weight loss surgery include;
1) Weight regain after initial weight loss.
2.) Inadequate weight loss.
3) Dumping syndrome.
4) Marginal ulcers.
5 ) Solid intolerance.
6) Anemia
7) Nutritional deficiencies.
8) Significant bowel dysfunction.
9) GERD
10) Infected ports and bands (implanted devices)
11) Erosion or slippage of the adjustable band.
12) Recurrence or only partial resolution of comorbid conditions.
13) Stricture or narrowing at the site of bowel anastomosis.
Complication of Roux en Y gastric bypass are dumping syndrome, marginal ulcers and persistant nausea vomiting with solid intolerance, inadequate weight loss or weight regain. In almost all the cases the best option for Roux en Y gastric bypass that is in need of revision is the duodenal switch operation. Adjustable gastric banding ( Lap Band) placement as a weight loss surgery for a primary Roux en Y may only be indicated for patients that have had initial success of weight loss followed by weight regain. This however, should be in the absence of dumping syndrome, marginal ulcers or reflux disease, which can potentially get exacerbated by placement of a band on top of the gastric pouch.
Adjusting the length of the common channel, alimentary limb, allows a revisional weight loss surgery to be tailored to the patient's needs. In case of a patient having a revision of Roux en Y for persistent nausea and vomiting with an adequate weight loss, a relatively long common channel and alimentary limb ( percentage based ) will be set for the patient, thus preventing any further weight loss yet correcting the persistent nausea and vomiting issue. In contrast, a patient that is seeking revision of a failed gastric bypass to duodenal switch for inadequate weight loss or weight gain will have a relatively shorter common alimentary channel (percentage based) in order to maximise the amount of weight loss. Revising a failed gastric bypass from proximal to distal Roux en Y is seen to be a poor choice in the majority of patients due to the fact that the distal gastric bypass has the worst nutritional safety profile of all the known surgical procedures. Consult your bariatric surgeon for any complications post gastric bypass. This can be corrected by a revisional surgery.


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