Pouch revision surgery sounds like a procedure best suited for a kangaroo. The pouch in this case refers to changes that occurred during a previous weight loss procedure. Pouch revision aims to correct those changes to revive weight loss when the results of the original surgery were less than ideal.
To better understand why this technique is needed, it helps to understand the changes that happen during weight loss surgery, the intended results, and why those results sometimes miss the mark.
What is Pouch Revision Surgery?
Pouch revision is a bariatric procedure that addresses changes that have taken place during a previous weight loss procedure. When the original surgery failed to bring about significant weight loss, the patient may be left wondering if they did something wrong. In some cases, the initial surgery succeeded in helping the patient lose weight only for the patient to regain some weight later. In both cases, the patient may not be to blame. The culprit may be the stomach.
Two of the most popular weight-loss surgeries are the gastric sleeve and gastric bypass procedures. During both surgeries, around 80% of the stomach tissue is removed. This will thus create less volume for food to traverse on its way to digestion. The remaining tissue is fashioned into a pouch, which is also referred to as a sleeve. This is where the gastric sleeve gets its name.
In some cases, the stomach can stretch, returning some of the original volumes. When this happens, the patient may fail to lose weight, or the patient may gain weight at a later date. In both cases, a pouch revision procedure may be necessary.
Pouch revision surgery aims to shrink the stomach volume to create the necessary conditions for long-term weight loss.
Read our article: Fight Weight Regain with a Pouch Revision
How Do Doctors Determine When Pouch Revision is Needed?
Doctors have a good indication that a pouch revision is necessary when you are able to eat more than you could following the initial surgery. With a smaller stomach, you are restricted to eating smaller portions and smaller meals overall. You also feel fuller faster while eating.
When the stomach stretches and volume are restored, you are able to eat more. That is when weight regain could be possible.
Doctors do not rely on indications, however. Testing is necessary to determine when pouch revision surgery is needed.
How Doctors Test to Determine Your Candidacy for Pouch Revision
Bariatric surgeons use what is called an esophagram to evaluate the shape of your anatomy. The test consists of an X-ray of your esophagus and stomach. The results can determine if a pouch revision is necessary to reinvigorate weight loss.
How is a Pouch Revision Performed?
The techniques used during pouch revision surgery depend on the type of bariatric surgery you originally had.
Pouch Revision Surgery for the Sleeve Gastrectomy
If you underwent gastric sleeve surgery, pouch revision may involve transitioning your surgery to a gastric bypass procedure. While both gastric sleeve and gastric bypass involve shrinking the stomach by cutting away the majority of the tissue, gastric bypass goes a bit further. The smaller stomach is rerouted to a section of your intestine. This allows for a combination of restriction and diminished nutrient absorption, leading to even more significant weight loss.
Bariatric surgeons tend to prefer transitioning patients from a gastric sleeve to a gastric bypass when weight regain and/or acid reflux occurs following the original surgery. The patient goes on to lose more weight and experiences less discomfort after the secondary procedure.
Pouch Revision After Gastric Bypass Surgery
If you have already had a gastric bypass and are experiencing weight regain, your surgeon may perform a technique known as sleeving the bypass. During this technique, the surgeon removes a section of the pouch. He will also reduce the size of the passageway leading to the intestines. This further restricts the amount of food you are able to digest.
The surgeon may also prefer to bypass even more of the intestines, which leads to less nutrient and calorie absorption. Because gastric bypass surgery and pouch revision following gastric bypass can lead to nutrient deficiencies, you may be required to supplement with vitamins and minerals to achieve optimal health.
There is a separate option known as endoscopic repair. During this technique, the surgeon tightens the connections between the stomach and intestines. This further restricts the amount of food you can eat and can help to recharge your weight loss, though doctors are not sure how long the results last.
Pouch Revision After Gastric Band
There is one additional bariatric surgery we have not mentioned. The reason we have kept quiet about this procedure is that gastric banding has fallen out of favor in recent years. Better known by the brand name Lap-Band, the adjustable gastric banding procedure used to be the preferred method of weight loss for morbidly obese patients. After years of being optimistic about the Lap-Band, both doctors and their patients began to notice less than favorable complications.
Read our article: Is Lap Band Surgery Still a Viable Solution for Morbid Obesity?
Not only did many gastric banding patients regain weight following their initial surgeries, but many of them also experienced pain, vomiting, and other awful side effects.
Today, doctors understand that most patients fitted with a Lap-Band will require a follow-up revision surgery.
During the initial gastric banding surgery, a prosthetic device is fitted around the upper portion of the stomach. The effect leads to the restriction of food intake. It is similar to the outcome of the gastric sleeve and gastric bypass procedures. The difference is that the Lap-Band is reversible while the latter surgeries are permanent.
The Lap-Band causes complications because it can slip down further on the stomach and lead to food leakage, among other horrible issues. Lap-Band revision surgery is then needed to remove the band from around the stomach.
Read our article: Lap Band Revision Surgery Can Get Your Weight Loss Back on Track
In many cases, bariatric revision is used to transition the patient from the Lap-Band to a more effective surgery, such as the gastric sleeve or gastric bypass.
Lap-Band to Gastric Sleeve Revision
When transitioning from the gastric band to a gastric sleeve, the band will be removed, along with all the scar tissue surrounding the prosthetic device. The surgeon then proceeds with the sleeve gastrectomy or gastric sleeve. As you now know, it involves the removal of the majority of your stomach tissue.
In some cases, surgeons will combine the gastric sleeve with the repair of a hiatal hernia, which can occur on account of the gastric banding device.
Following the Lap-Band to gastric sleeve transition, patients are able to lose around 65% of their excess body weight.
Read our article: Can You Convert a Lap-Band to a Gastric Sleeve?
Lap-Band to Gastric Bypass Surgery Revision
When performing a revision of the gastric band to gastric bypass, the procedure is usually performed in a single session. The band is removed, along with any scar tissue that is present, before the gastric bypass is performed. The stomach tissue is cut away and the intestines rerouted. This will lead to an average weight loss of 75% of the patient’s excess body weight.
In all cases, surgeons prefer to use laparoscopic surgery because of the lowered chances of complications. During laparoscopic surgery, small incisions function as entry points for serpentine tools. One of the tools is fashioned with a camera and light. It will allow the surgeon to perform the procedure while viewing your internal organs on a monitor in the operating room.
Because your body cavity is not opened like traditional surgeries, your risks become lowered, and recovery time is shortened. You also have smaller scars that usually fade and become hidden over time.
Read our article: How Gastric Bypass Surgery Makes Weight Loss Easier
What Results Can You Expect Following The Surgery?
Pouch revision tends to deliver good outcomes when performed by an experienced bariatric surgeon. You can expect to lose more weight after the second surgery. If you experienced gastric reflux before the pouch revision, you should have diminished symptoms or a reversal of the condition entirely. In essence, having a bariatric revision can give you a second start on your weight loss journey, giving you more improved chances of keeping the excess weight off over the long term.
What is Recovery Like After The Surgery?
Pouch revision recovery is similar to gastric sleeve and gastric bypass procedures. You can expect to go home a day or two after the procedure, after a short stay in the hospital or surgical center while your vital signs are monitored. You may find that recovery takes a day or two longer after the second surgery because of the presence of scar tissue and altered blood supply. Once you return home, the recovery experience tends to be the same as both surgeries, with you returning to your everyday activities after a few weeks of taking it easy.
Is Pouch Revision Surgery Covered by Insurance?
All insurance companies have their own requirements. Some insurers cover bariatric revision, and some do not. Check with your insurance company and policy for details.
Are You a Suitable Candidate for Pouch Revision Surgery?
You might be a viable candidate for bariatric revision if you have gained weight and/or experience gastric reflux following the original weight loss procedure.
To qualify for a pouch revision, your surgeon must be able to determine that your stomach has regained volume after a series of diagnostic tests. You must also have a healthy esophagus since endoscopic surgery relies on cameras and thin tubes to be inserted through that pathway. Although incisions are also made in the abdominal region to perform the surgery in many cases.
You must be committed to your weight loss journey to qualify for revision surgery. Weight regain may be caused by an increase in stomach volume, ‘may’ being the operative word. But if you have not maintained a healthy lifestyle as directed by your bariatric surgeon and others involved in your weight-loss treatment, such as dieticians, psychology experts, and fitness specialists, you may be denied a pouch revision until you are ready to commit to a long-term weight loss plan.
You might not be a candidate for pouch revision if your weight gain is not related to an enlargement of your stomach or the pouch and outlet connected to your intestines. You may also be denied if you are of poor health or demonstrate a medical condition that compromises the health of your esophagus.
The best way to determine your candidacy for a bariatric revision is to schedule a consultation with your original bariatric surgeon. You are also encouraged to get a second opinion by visiting a separate surgeon to get their take.
Schedule a Consultation with Dr. Moein
If you live in the Los Angeles area, schedule a consultation with Dr. Babak Moeinolmolki of Healthy Life Bariatrics. Dr. Moeinolmolki (Dr. Moein for short) has over three decades of experience as a bariatric surgeon. Dr. Moein also specializes in pouch revision, other bariatric revision procedures, and post-bariatric body contouring surgery. The latter is useful for attaining a more attractive figure after the weight has come off. Dial now to schedule your appointment and learn more about your options. (310)694-4486.