Revision / Conversion Surgery

Patients who have gastric bypass occasionally require revision, either for inadequate weight loss or for complications. Gastric bypass patients with anatomically intact operations and unsatisfactory weight loss have probably "outeaten" the operation.

Metabolic Complications After Bypass Revision

Gastric bypass patients with unsatisfactory weight loss are best converted to a more malabsorptive modification of Roux-en-Y gastric bypass, or in some cases biliopancreatic diversion. Unfortunately, some patients who are converted to a malabsorptive procedure suffer severe metabolic complications. Patients with staple-line breakdown after Roux-en-Y gastric bypass should have transection of the stomach between staple lines because of the high incidence of subsequent disruption observed in patients who have had restapling in continuity. Roux-en-Y gastric bypass patients with stomal stenosis and an intact staple line who fail endoscopic dilatation should have revision of the gastroenterostomy. Large-volume gastric pouches should be reduced when technically feasible.

Patient Non-Compliance With Eating Guidelines

A small number of morbidly obese patients will outeat any bariatric operation. Whenever a patient has failed a second technically sound and intact operation, surgeons should approach the prospect of a further revision with considerable caution and skepticism. Rejection of such patients for another operation is frequently a prudent decision.