| Frequently
Asked Questions |
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| What
problems are caused by failed weight-loss procedures? |
 When
weight-loss procedures fail, they can result
in significant metabolic and physiologic disturbances.
They also can cause devastating psychological
and emotional consequences, which often are
the least recognized consequences following
a failed operation.
Almost all patients who suffer from this problem
have gone through the same cycle of emotions.
After years of struggling with failed dieting
attempts and severe obesity, they are accused
of "taking the easy way out" by
both family and friends alike when they seek
surgical options. Then the initial success
with surgery is received with mixed emotions
by the same naysayers when the procedure begins
to fail. The natural response is to blame
the patient. The accusations start to fly,
with some patients hearing degrading remarks
such as "You couldn't even do it with
the surgery!" Unfortunately, these and
other comments just add insult to injury.
At this most fragile point in time, many surgeons
also will place the blame or fault on the
patient without an adequate evaluation. Sadly,
in the majority of cases patients will not
find assistance from their primary surgeon.
The typical search for a consulting surgeon
to fix the failed procedure can be heart-wrenching
and seem endless since most surgeons aren't
willing to take on these types of problems.
When another surgeon finally is found, typically
a complete evaluation is offered. In many
cases a mechanical issue is identified for
the "failure" and a revision or
correction is suggested.
Every patient considering a revision procedure
needs to know it is not without some amount
of risk, and requires more courage and support
than the primary procedure itself. Even on
the second attempt (which is medically indicated),
most patients report little support is offered
by family and friends. These emotional scars
are very difficult to heal. However, when
a revision is performed by a surgeon experienced
in such procedures a much higher chance for
a success is enjoyed. And as the pounds begin
to go away, so too do many of the emotional
scars.
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| Why
do procedures fail? |
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| A
surgical weight-loss procedure could fail
for a number of reasons, including:
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| 1. |
The patient regresses
back to his/her "old habits,"
and strays away from the recommended diet
and exercise program
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| 2. |
Mechanical complications
following an appropriately constructed
operation; for example, "pouch stretching,"
"slipped bands," and/or "fistulas."
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| 3. |
Failure happens due
to the natural history of the procedure;
for example, the vertical-banded gastroplasy
or the jejunal-ileal bypass.
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| What
are the symptoms of a failed procedure? |
Below are the typical symptoms associated
with four failed weight-loss procedures. (Note:
Some patients have different symptoms.) In
all cases, be aware it's normal to experience
weight regain after initial success or a premature
plateau in weight-loss early after the procedure.
If you think you may be experiencing a failed
procedure, the first thing to do is to start
a daily diary of your diet and exercise activity.
Concurrently, contact your surgeon and nutritionist
so they can rule out non-compliance; meaning
that the procedure is failing because you're
not following "doctor's orders"
about what to do-or not do-after surgery.
| 1. |
Failure after a
vertical-banded gastroplasty
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| a. |
High frequency
of vomiting shortly after meals
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| b. |
Decreased tolerance
for solid foods (such as meats)
and roughage
(such as salad)
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| c. |
Chronic unremitting
reflux
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| d. |
Non-healing ulcers
found during an endoscopy |
| e. |
Chronic epigastric
pain (pain just below the breast
bone) |
| f. |
Increased capacity
for food |
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| 2. |
Failure after a
jejunal-ileal bypass
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| a. |
a. In theory,
regardless of the symptoms a patient
may or may not have, all jejunal-ileal
bypasses should be reversed due
to possible life-threatening liver
failure. Individuals should always
seek the guidance and services
of an experienced bariatric surgeon
to have this procedure done.
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| 3. |
Failure after
a laparoscopic adjustable band
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| a. |
Increased capacity
to food despite numerous band
"adjustments"
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| b. |
High frequency
of vomiting shortly after meals
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| c. |
Decreased tolerance
for solid foods (such as meats)
and roughage
(such as salad)
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| d. |
Chronic unremitting
reflux |
| e. |
Non-healing ulcers
found during an endoscopy |
| f. |
Chronic epigastric
pain (pain just below the breast
bone) |
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| 4. |
Failure after gastric
bypass |
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| a. |
Development of
frequent emesis
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| b. |
Increased capacity
for food
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| c. |
Refractory
strictures
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| d. |
Uncontrollable "dumping"
of wastes |
| e. |
Pre-mature plateau
in weight loss |
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The above list only represents
the most frequently recognized symptoms; many
others exist. That's why it's important for
all patients to be followed closely by their
primary bariatric surgeons. If such follow-up
is not offered or no longer possible, it is
imperative that the patients seek alternative
surgeons. Patients suffering from symptoms
similar to those listed above, or who have
had a significant change in the way they feel,
should request a thorough post-procedure examination
and evaluation by their surgeons. A second
opinion may be necessary if the primary surgeon's
level of expertise is not extensive. Also,
patients should not hesitate to seek alternative
opinions if it's believed the symptoms were
not thoroughly evaluated, or have somehow
changed.
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| What
is done during a revision operation? |
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Unfortunately, there is no "standard of
care" when it comes to fixing failed bariatric
procedures. This is because most surgeons do
not have extensive experience in revising bariatric
procedures. That's why it is imperative that
a patient choose a revision surgeon even more
carefully than the original primary surgeon.
During a revision, most experienced surgeons
will take an evidence-based approach.
Surgical options for a revision include:
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| 1. |
Vertical-banded gastroplasty
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| a. |
Re-banding the gastroplasty
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| b. |
Re-doing the vertical
staple line
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| c. |
Conversion to
a gastric bypass
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| 2. |
Jejunal-ileal bypass
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| a. |
Restoration of normal
anatomy
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| b. |
Conversion to a
gastric bypass
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| 3. |
Laparoscopic adjustable
gastric band
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| a. |
Re-banding
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| b. |
Conversion to a
gastric bypass
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| 4. |
Gastric bypass |
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| a. |
Re-sizing the pouch
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| b. |
Re-creating the
gastrojejunostomy
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| c. |
Lengthening the
bypass
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| d. |
Banding of the bypass |
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As mentioned, there is no standard
operation following a failed procedure. When
taking an evidence-based approach, most surgeons
agree that the gastric bypass is the best option
following any failed procedure. They also agree
that once a banding operation has failed (either
a vertical banded gastroplasty or a laparoscopic
adjustable band), the best surgical option is
the gastric bypass. As far as the jejunal ileal
bypass is concerned, the decision of restoration
versus conversion to bypass is based on the
patient's desires and present weight.
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| How
risky is the operation? |
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In general, all revision operations are two
to five times more risky than a primary operation.
Whatever risks were quoted to a patient before
his or her first operation should be adjusted
to reflect this increased risk.
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| What
are the expected results of a revision operation? |
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As ironic as it may sound, the main goal of
a revision operation is to restore the patient's
ability to eat a well-balanced meal without
distressing symptoms (e.g., pain, nausea, emesis).
In doing so, the secondary objective is to restore
emotional and psychological health. Last but
not least, the revision's third objective is
to achieve goal weight. What this means is that
failure to achieve goal weight alone may not
be enough to qualify for a revision. The risk
associated with the procedure must be offset
by the benefits. (Most surgeons will agree that
weight-loss should not be the only goal of the
revision.) Many patients don't realize that
after a revision, weight loss is generally slower--and
the percentage of excess weight lost sustained
is slightly lower--than what is experienced
after a primary procedure.
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| How
do I choose a revision surgeon? |
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After deciding to have a revision, perhaps the
most critical step of the revision process is
finding the right surgeon to do it. The bottom
line on this is that your revision surgeon should
be the most experienced doctor available to
you. He should have performed an extensive number
of revisions in the past, and provide you with
their results without hesitation. Always seek
a second opinion if your surgeon insists on
re-banding a vertical banded gastroplasty or
re-doing a laparoscopic adjustable band since
the failure rate for these procedures may not
be acceptable given the risk of the revision
itself. This second opinion should be secured
from someone other than your primary surgeon,
and not in the same practice.
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| How
can Texas Bariatric Specialists help me? |
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Our practice has extensive experience in "troubleshooting"
procedures which are believed to have failed.
After doing thorough evaluations, we've helped
more than 90% of our patients who experience
symptoms and troubles following vertical-banded
gastroplasties and laparoscopic bands. That
amazing success rate should give you great comfort,
peace of mind, and hope for an opportunity to
regain your health. Click HERE to start a conversation
with us about how we can help you.
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| How
can I be helped if I live outside Texas? |
You can still tap into our expertise in revising
failed procedures if you don't live in Texas.
On a consultative basis our practice will review
your files and x-rays to provide an expert opinion
about your symptoms and underlying problem.
Oftentimes we can make a case to get you help
without further testing. Contact
us today to set up a free phone consultation
with Dr. Patel of Texas Bariatric Services.
We can give you the professional assistance
you've been seeking to help you reclaim your
life! |
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