Revision Weight Loss Surgery

Heartburn – Reflux – hiatal Hernia after weight loss surgery 

One of the most common complaints that leads to revision weight loss surgery is heartburn or reflux.  Often the symptoms experienced by the patients are caused by other reasons than acid alone

The heartburn - reflux like symptoms can be caused by:

  • Acid reflux

  • Herniation of the sleeve or bypass pouch into the chest in such a manner that it is now causing a partial obstruction to the passage of food

  • Bile refluxing up into the stomach and esophagus

  • Stricture / Obstruction formation

  • Torsion (twisting of the sleeve)

Next steps / Options

When experiencing the symptoms or complications described above get help. Find a bariatric surgeon (weight loss surgeon) as soon as possible who does revision surgery. The symptoms will usually continue to get worse not better.

The best studies to diagnose the problem is an UGI (upper gastric swallowing study) and an Upper Endoscopy (scoping of your stomach) to evaluate the function of your weight loss operation and determine what has changed about your weight loss operation since your surgery.

After the UGI and Upper Endoscopy it should become apparent what is causing the problem(s) you are experiencing, and the surgeon will start discussing with you what can and cannot be done to correct or improve the problem.

Your options may include:

  • Changing your medication regimen

  • Staring a new medication

  • Stretching of a stricture

  • Reversing the weight loss operation

  • Revision of an anastomosis

  • • Reducing pouch size / Anastomosis size

  • Converting the weight loss operation to another weight loss operation

  • Undergoing a Hiatal Hernia reduction and repair of the trapped stomach in the chest

One of the most common complaints that lead to revision weight loss surgery is heartburn or reflux. Often the symptoms experienced by the patients are caused by other reasons than acid alone.

The heartburn - reflux like symptoms can be caused by:

  • Acid reflux

  • Herniation of the sleeve or bypass pouch into the chest in such a manner that it is now causing a partial obstruction to the passage of food

  • Bile refluxing up into the stomach and esophagus

  • Stricture

Lap-Band Revisions 

Though the Lap-Band used for weight loss in individuals who have failed to lose weight through diet and exercise, many patients can experience sub-optimal weight loss despite the surgery, or develop complications.  In such cases, revision weight loss surgery may be needed to induce or maintain weight loss or correct a complication. 

If you are experiencing:

  • difficulty swallowing that is causing you to cough/choke/throw up when you eat, lie down or sleep

  • food getting stuck repeatedly

  • Eating mostly a liquid, saucy, crunchy and flaky food diet and avoiding the more solid, dry, dense or doughy foods

  • Having progressive trouble with heartburn / reflux that is not responding to medication anymore

You may have one of these complications:

·      Lap-Band intolerance  (inability to eat solid food)

  • Esophageal dilatation  (stretching of the swallowing pipe)

  • Obstruction of the Lap-band  (band too tight, band too high, band slippage – too much stomach above the band)

  • Lap-band slippage  (pouch has become large and intermittently is causing obstruction)

  • Lap-Band erosion  (band rubs into the stomach)

Next steps / Options

When experiencing the symptoms or complications described above get help. Find a bariatric surgeon (weight loss surgeon) as soon as possible who does revision surgery. The symptoms will usually continue to get worse not better.

The best studies to diagnose the problem is an UGI (upper gastric swallowing study) and an Upper Endoscopy (scoping of your stomach) done by a bariatric surgeon to evaluate the function of your band and determine what has changed about your lap-band, stomach and esophagus since lap-band surgery.

After the UGI and Upper Endoscopy it should become apparent what is causing the problem(s) you are experiencing, and the surgeon will start discussing with you what can and cannot be done to correct or improve the problem.

Your options may include:

  • Inflating / Deflating the lap-Band

  • Removing the Lap-Band

  •   Converting the Lap-band to a Sleeve gastrectomy

  • Converting the Lap-Band to a Gastric Bypass

  • Undergoing a Hiatal Hernia reduction and repair with/without an anti-reflux procedure

Gastric Sleeve Revisions 

The Sleeve Gastrectomy operation is used in morbidly obese patients to lose weight. Some patients can experience sub-optimal weight loss despite the surgery, or develop complications.  In such cases, revision weight loss surgery may be needed to induce or maintain weight loss or correct a complication. 

If you are experiencing:

  • heartburn / reflux that is getting progressively worse and medication is not controlling it

  • difficulty swallowing that is causing you to choke/throw up when you eat, lie down or sleep

  • Chest pain after eating

  • Eating mostly a liquid, soft, saucy, crunchy and flaky food diet and are avoiding the more solid, dry, dense or doughy foods

  • Significantly lower weight loss than predicted

  • Significantly higher weight loss than predicted

You may have one of these complications:

  • Heartburn / reflux / Hiatal hernia

  • Incarcerated / Herniated sleeve (sleeve trapped/herniated into the chest)

  • Stricture / torsion of sleeve (narrowed or twisted causing obstructive problems)

  • Biliary reflux/gastritis/esophagitis (bile causing irritation of stomach and esophagus)

  • Large Sleeve

  • Incomplete Sleeve

Next steps / Options

When experiencing the symptoms or complications described above get help.  Find a bariatric surgeon (weight loss surgeon) as soon as possible who does revision surgery.   The symptoms will usually continue to get worse not better.

The best studies to diagnose the problem is an UGI (upper gastric swallowing study) and an Upper Endoscopy (scoping of your stomach) to evaluate the function of your sleeve and determine what has changed about your sleeve since your surgery.  

After the UGI and Upper Endoscopy it should become apparent what is causing the problem(s) you are experiencing, and the surgeon will start discussing with you what can and can not be done to correct or improve the problem. 

Your options may include:

       Changing your medication regimen

·       Staring a new medication

·       Endoscopic Stent placement

·       Re-sleeving the sleeve

·       Converting the Sleeve to a Gastric to Bypass

·       Undergoing a Hiatal Hernia reduction and repair of the trapped sleeve in the chest

Gastric Bypass Revisions

The Gastric Bypass operation is used in morbidly obese patients to lose weight. Some patients can experience sub-optimal weight loss despite the surgery, or develop complications.  In such cases, revision weight loss surgery may be needed to induce or maintain weight loss or correct a complication.

If you are experiencing:

  • heartburn / reflux that is getting progressively worse and medication is not controlling it

  • difficulty swallowing that is causing you to choke/throw up when you eat, lie down or sleep

  • Eating mostly a liquid, saucy, crunchy and flaky diet and can-not eat the more solid, dry, dense or doughy foods

  • Epigastric abdominal pain (area between the chest and abdomen)

  • Significantly lower weight loss than predicted

  • Significantly higher weight loss than predicted

You may have one of these complications:

  • Marginal ulcer

  • Stricture, Stricture with high grade obstruction

  • Gastro - Gastric Fistula

  • eartburn / reflux

  • Incarcerated / Herniated pouch (more common if patient was converted from sleeve to bypass – pouch is trapped/herniated in the chest)

  • Biliary reflux/gastritis/esophagitis (bile causing irritation of stomach and esophagus)

  • Large gastric pouch / horizontal gastric pouch

Next steps / Options

When experiencing the symptoms or complications described above get help.  Find a bariatric surgeon (weight loss surgeon) as soon as possible who does revision surgery.   The symptoms will usually continue to get worse not better.

The best studies to diagnose the problem is an UGI (upper gastric swallowing study) and an Upper Endoscopy (scoping of your stomach) to evaluate the function of your bypass and determine what has changed about your bypass since your surgery.  

After the UGI and Upper Endoscopy it should become apparent what is causing the problem(s) you are experiencing, and the surgeon will start discussing with you what can and can not be done to correct or improve the problem. 

Your options may include:

• Changing your medication regimen

• Staring a new medication

• Stretching of the gastro-jejunostomy (stricture)

• Reversing the bypass operation

• Revision of the gastro-jejunostomy (pouch outlet)

• Reducing pouch size / Anastomosis size

• Converting the Sleeve to a Gastric Bypass

• Undergoing a Hiatal Hernia reduction and repair of the trapped pouch in the chest