Introduction: Understanding when gastric band revision surgery is needed
If you 'have completed weight-loss surgery, it can be disheartening when the procedure doesn't work as planned. You may completed an uneventful gastric band surgery and followed all the after-surgery recommendations and still not quite achieved the weight loss you desired.
Just like any disease, one treatment for obesity does not fit all patients. You may need revision surgery if you fail to lose notable weight or regain the weight you lost in the initial months.
Sometimes, gastric band revision surgery may be necessary to help you achieve your weight-loss goals and optimal health.
Bariatric procedures like gastric banding can be an effective treatment for obesity and related health conditions. According to the American Society for Metabolic and Bariatric Surgery (ASMBS), over 250,000 bariatric procedures were performed in 2018 alone [1]. However, as with any surgery, complications can occur over time that may require revision procedures to correct issues with the band. This article will explore common reasons why gastric band revision surgeries are performed.
What is gastric band surgery?
During gastric band surgery, the doctor performs laparoscopic surgery to place an adjustable silicone band around the upper part of your stomach. The band shrinks the amount of food your stomach can hold to just about an ounce.
Why gastric band surgery fails
Revision surgery may be necessary if a different provider, other than Dr. Moeinolmolki, improperly performed the procedure. Alternatively, changes in your anatomy or shifts in your weight due to new lifestyle factors, such as added stressors impacting eating and exercise habits, can also warrant consideration.
You may also select gastric band revision surgery because you and the doctor decide another procedure would be more appropriate for you, such as sleeve gastrectomy or gastric bypass.
In some people, the stomach stretches out considerably in the years following the gastric band surgery, so more food can fit in the stomach, which hampers weight loss and maintenance of weight loss. It's normal for the stomach to stretch somewhat with time.
The band may also slip or loosen with time, so your stomach gets closer to its original size, so you have greater hunger and trouble sticking to dietary restrictions.
One of the most common reasons patients seek a revision surgery is lack of weight loss or weight regain after undergoing gastric banding [2]. There are several potential causes for this:
- The band may have slipped out of position or expanded allowing increased food intake [3]
- The stomach pouch above the band may have stretched allowing more food intake [4]
- Eating high calorie liquid and soft foods can defeat the restriction from the band [4]
- Lack of compliance with diet and lifestyle changes [3]
To troubleshoot a weight loss plateau, a gastroenterologist may order imaging tests and evaluate if tightening the band or surgical revision is necessary [4].
Band Slippage and Damage
Gastric bands can occasionally slip out of position or become damaged. Signs of band failure include:
- Inability to swallow food or liquids
- Reflux/heartburn
- Regurgitation of partially digested food
- Weight gain
A barium swallow x-ray or endoscopy can confirm band slippage [5]. Band revision surgery is usually necessary to reposition or replace the damaged band.
Band and Tubing Leaks
While rare, the band, port, or connecting tubing may develop leaks. Symptoms of a leak include inability to tighten the band properly, swelling around the port, weight gain, and abdominal pain [5]. These often require urgent surgical revision to prevent serious complications like infection or band erosion through the stomach wall [6].
Inability to Tolerate the Band
Some patients have chronic difficulties tolerating gastric bands, which may negatively impact quality of life. Common problems include dysphagia (trouble swallowing), heartburn, and regurgitation [6]. Conservative options include band deflation and trying dietary modifications [5]. However, band removal may provide symptom relief if conservative treatments fail.
Conclusion: While gastric bands can be very helpful for weight loss, complications like band slippage, leaks, damage, or intolerability may require surgical revision in some cases. Working closely with a bariatric surgery team is important for promptly diagnosing and addressing any band-related issues.
How do I know revision surgery is right for me?
Revision surgery is often needed when you regain weight following gastric band surgery. This may happen several years after your initial surgery.
Obesity is a chronic disease that can be managed with surgery but not cured. Weight regain can occur due to lifestyle changes, such as childbirth, a new relationship, shifts in eating habits, financial stress, or changes in employment. In such cases, you may find it challenging to sustain the lifestyle adjustments and dietary recommendations associated with gastric band surgery, necessitating the exploration of alternative options.
If your band failed, and you find yourself hungrier than you were in the months right after surgery, a revision may also be necessary.
If you need gastric band revision surgery, you're not alone. Up to a third of patients who had gastric band surgery need a revision to maintain weight loss or continue to lose weight.
Sleeve gastrectomy
You may be a candidate for sleeve gastrectomy, in which a portion of the stomach is removed entirely, leaving a banana-like structure. With sleeve gastrectomy, the changes to the size of your stomach are permanent, so you eat less and experience changes in the hormones affecting appetite.
Gastric bypass
With gastric bypass, Dr. Moeinolmolki divides your stomach into a small upper pouch for food processing and a larger lower portion bypassed. You have a permanently smaller stomach, so you get full fast, and with time, you'll also experience alterations in the hormones that affect appetite.
Conclusion: Understanding when gastric band revision surgery is needed
If you've had gastric band surgery, but it's just not helping you maintain lost weight or lose additional weight, you may need a revision. The need for a revision is common and not a moral failing. If you live in Los Angeles and want to discuss gastric band revision surgery, contact Healthy Life Bariatrics to learn about your options.
References:
[1] American Society for Metabolic and Bariatric Surgery estimates, 2018
[2] Karmali S, et al. Bariatric surgery and bariatric procedures. Can Fam Physician. 2011 Jun; 57(6): 665–671.
[3] Oji T, et al. Indications for revisions following 630 consecutive laparoscopic adjustable gastric banding cases at a single institute. Obes Surg. 2012 Sep;22(9):1403-8.
[4] Parmar CD, et al. What happens to the defunctioned gastric segment after gastric bypass surgery? Curr Opin Clin Nutr Metab Care. 2011 Jul;14(4):406-10.
[5] Brown WA, et al. Band erosion is real, can be dangerous, and common after gastric banding. Surg Obes Relat Dis. 2019 Nov;15(11):1907-1912.
[6] O’Brien PE, et al. The laparoscopic adjustable gastric band (Lap-Band®): a prospective study of medium-term effects on weight, health and quality of life. Obes Surg. 2002;12(5):652-60.
