After gastric bypass surgery, some patients do not lose enough weight or gain it back after some time. Returning to a better quality of life without being overweight can help them with repeated (revision) gastric bypass surgeries. However, before proposing a revisional operation, detailed investigations must be done to find out the cause of the weight gain and to select the most appropriate surgical intervention. This may require the help of specialists from other fields, so it is best when their entire team works together. It is very important that reoperations are performed by experienced bariatric surgeons, as they require an extremely high level of professionalism and deep knowledge.

Success also depends on patient input

“Surgeries to correct excess weight are very safe and have a long-term effect. Their success depends on the surgeon performing a high-quality, efficient operation and the patient changing their physical activity and eating habits to healthier ones after the operation. Many patients succeed in this, because after these operations the hormonal balance changes, the feeling of hunger disappears, and because of the reduced stomach volume, they eat less. Because of this, some patients, unable to resist one of life’s pleasures – eating, return to an unhealthy diet within 5-10 years, and the weight gradually starts to increase again. No matter how successful the operation is, its results are erased in this case,” explains the well-known obesity surgeon Prof. medical Dr. Antanas Mickevičius.

According to the professor, patients who have already been operated on once and are unable to manage the situation on their own, usually turn to bariatric surgeons again, looking for help and trusting that they will get it. It has been established that if weight does not fall during the first year after the operation, the reasons are more often related to the operation itself, but if the weight regains later, it is usually due to too little personal contribution of the patient – he does not move much, does not exercise, eats too much, eats irregularly, overeats. Malnutrition can cause the stomach to expand again, increasing its volume. In cases where the tests confirm that anatomical correction can solve the problem, a second surgical intervention is suggested.

Various surgical corrections are available

It can be a certain modification of the same operation, remaking one operation into another, additional interventions can be performed, or other, less frequent operations can be chosen – there are many solutions. However, the optimal method of revision obesity surgery is chosen after a detailed examination and discussion of the likely risks and potential benefits of the operation with the patient. Most often, repeated obesity-correcting operations are performed after previous gastric banding, greater curvature of the stomach plication operations, and recently more cases of weight regain after marginal gastric sleeve have been observed.

In these cases, the most popular surgical correction is conversion to gastric bypass surgery, which not only reduces the stomach’s capacity, but also shortens the way food moves through the intestines. Gastric and pancreatic juices start digesting food later, some of it is not absorbed, so the body receives fewer nutrients and calories. If gastric banding was performed for the first time, the band is removed during repeat gastrectomy surgery. After repeated operations, a good result is usually achieved, the weight falls again, but the body already has the memory of the first operation and this process is a little slower.

In terms of security, it is not inferior to the original ones

If weight regains after gastric bypass surgery, it is especially important to find out the reasons for the failure of the operation, which in this case can be very diverse and complex, and only then plan a repeat operation. Repeated obesity-correcting operations are not inferior to primary operations in terms of safety, the frequency of perioperative complications reaches a few percent. However, the duration of revision operations can be longer, and the postoperative recovery is somewhat slower due to possible scarring processes, adhesions, altered anatomy after the previous operation. On the other hand, revision surgeries are performed by experienced surgeons and this happens very rarely.

Prof. medical Dr. Antanas Mickevičius emphasizes that a repeat operation can be performed for the third time, but it is necessary to consider that each subsequent operation is slightly more risky, their duration is longer, and the risk of postoperative complications is also slightly higher. All this is always discussed in detail together with the patient, the risks, the current situation, or the realistic expectations of the patient are measured a comprehensive preoperative examination is carried out, and only then a decision is made. He is very responsible, because not all anatomical changes made during the operation can be restored. And if a person does not change anything in his life even after the second operation, it is likely that the weight will start to grow again after a few years.

It is important to determine why the excess weight has returned

“One of the most important moments before the revision operation is to determine why the excess weight has returned, whether some health disorder or disease is to blame for it. Recently, I had to consult a patient who, after regaining significant weight from a previous gastric bypass surgery, went to bariatric surgeons in a Turkish clinic and underwent a repeat operation. Unfortunately, no research was conducted before this, the real reason for the return of excess weight was not clarified, and it did not have the expected effect. Undesirable weight changes can be caused by a changed hormonal balance, so a detailed examination by an endocrinologist is very important before revision obesity-correcting operations,” the interviewer asserts.

In some cases, overweight that has returned after surgery can be successfully corrected with medication. There are effective medications that are widely used in the world, with their help the patient’s condition improves, and in the long run it is possible to return to a normal weight. However, these drugs can only be prescribed by qualified professionals. Therefore, for a person who, a few or more years after the first obesity surgery, begins to accumulate excess weight again, no links with inappropriate habits can be established, preventive tests, consultations with doctors in certain fields are recommended, and only then a second surgery is considered.

The preoperative examination of the patient includes the assessment of motivation. If the bariatric surgeon sees that the patient is not motivated, surgical treatment is not recommended for such a person. In such cases, it can even cause harm. Let’s say if the stomach is reduced and a person, even after losing weight, suffers from the fact that he cannot eat as much as he wants and fully feel the pleasure of eating, as he could before the operation. For this reason, the patient’s quality of life suffers, he may feel psychological discomfort or even develop depression. A bariatric surgeon, seeing a lack of motivation, may refer the patient to a mental health specialist and only with his opinion make a final decision about surgery.

Safety and quality are guaranteed by a team of specialists

All the aforementioned services are offered by the “Newman Bariatric” clinic, where Prof. Prof. Bariatric Surgeon, recognized in Lithuania and abroad, works. medical Dr. Antanas Mickevičius, who has accumulated more than 15 years of experience in the field of obesity surgery, has performed more than 6 thousand operations in Lithuanian and British hospitals. He performs all globally recognized gastric reduction operations: laparoscopic gastric bypasses, laparoscopic gastric sleeves, aesthetic bikini line laparoscopic gastric sleeves, laparoscopic gastric plications, revision gastric reduction operations. It also uses a less invasive method of treating obesity – implantation of an intragastric  balloon.

At the Newman Bariatric Clinic, before any gastric bypass surgery, the clinic’s team of doctors conducts a thorough examination and a comprehensive assessment of the patient’s health. Here, highly qualified specialists in different fields work in one place to better understand and detect all possible health problems: doctor, nutritionist, endocrinologist, psychologist-psychotherapist, plastic surgeon, massage and sports medicine specialists. All of them help the patient to prepare for the operation and the changes that await after it. in order to achieve good results after gastric bypass surgery, it is necessary to properly prepare and plan everything down to the last detail.

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