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Weight Loss Revision Surgery in Mexico

The most experienced revision surgery team in Mexico

Can I Have Revision Weight Loss Surgery in Mexico / Mexicali?

Most patients will only need a single operation to accomplish the desired weight loss. But there are cases in which one bariatric weight loss surgery does not achieve the goals set initially Here are a few: Weight loss has been less than originally desired; due to the nature of surgery perhaps the patient was unable to modify eating habits; patients may still have comorbidities that a 2nd surgery may address; choosing the incorrect surgery initially due to specific anatomical characteristics the patient may have; in some cases there could even exist medical complications from the initial weight loss surgical procedure. Unfortunately weight loss surgery is not a one size fits all solution but fortunately there are different options available and surgeries can be revised to achieve better results. Dr. Esquerra and Dr. Wilhelmy are among the top bariatric weight loss surgeons in Mexico and are able to offer a wide range of quality treatments to first-time weight loss surgery patients as well as for those who had been previously one. Revision surgeries offer patients another chance towards a healthier life and long term weight loss maintenance.

Revision surgeries are now being performed by experienced revisión surgeon Dr. Wilhelmy & Dr. Esquerra

Risks and results of Revision Weight Loss Surgery

 

Undergoing Revision Weight Loss Surgery is a very important decision in which risks and benefits are brought into the light for consideration. Revision surgery implies higher risks than the ones taken in a first time procedure, and these are some reasons why:

  • -Operation time for Revision weight loss surgery is longer.
  • There are frequent unnecessary incisions…
  • … thus producing a larger blood loss.
  • Infections and leakage happen more frequently. Leak rates increase because of changes regarding the blood flow towards the stomach due to a previous weight loss surgery.

Usually revision surgery is far more predictable regarding medical conditions treatment, not on weight loss itself. Weight loss rate decreases after Revision surgery. This is caused by metabolic adjustments happening after first time surgery. Patients with slower metabolism (also known as “metabolically obstinate”) usually underachieve after first time surgery, in these cases a revision to a metabolic surgery is advised.

Because of the particular needs and biology of every single patient requiring Revision Weight Loss Surgery, each of these procedures is planned on a personalized basis to meet unique desired conditions.

Why Should I Consider Undergoing Another Weight Loss Surgical Procedure, This Time A Revision Bariatric Surgery?

 

  • Weight Regain and / or Inadequate Weight Loss

These are the most common reasons to undergo Revision Weight Loss Surgery, since not every single individual fits into the “average patient” profile, weight loss doesn’t happen with any single bariatric surgery in the same quantities. sometimes a surgery that did the job for a certain set of patients does accomplish the exact same achievements for another individual, but sometimes it does not. This is why there are different types of bariatric surgeries.

  • Some persons have a hard time or total inadequacy at adapting to the new lifestyle that should be engaged after a particular bariatric procedure, revising to a different procedure may improve quality of life for the individual.
  • A specific kind of procedure does not properly address a certain patient’s metabolic needs, such as diabetes not being resolved with a sleeve and converting to a DS or Bypass.
  • The anatomical changes happening to the patient’s biology during bariatric surgery are not maintained afterwards, such as a stretch stoma, slipped band, stretched sleeve, etc.

 

The bariatric surgical procedure can fail due to some or all of the above mentioned reasons. Before deciding to undergo Revision surgery, it’s very important to establish whether the bariatric weight loss procedure was inadequate for the patient or rather if the patient failed the surgery (and therefore the whole weight-loss process). Sometimes, a patient does not receive enough information previous to undergoing a bariatric surgical procedure in order to select the best procedure according to his/her biology, needs and/or expectations; other times a patient is not properly instructed about the necessary changes in eating and/or exercising behavior after a weight loss surgery in order for the procedure to work the best for them; these delicate procedures require a full heads-on follow-up from patients in order to keep being successful long term, and following instructions from specialists as not to gain back undesired weight.

It is often that the bariatric surgery’s failure is due to metabolically and/or mechanical problems. The latter are caused due to anatomical changes (made during first time weight loss surgery) not being maintained in the short to mid-term after an intervention, some of these examples are:

  • Pouch enlargement.
  • Gastric pouch outlet’s diameter increases.
  • A gastric fistula (also gastro fistula) has recently formed between the bypassed stomach and the gastric pouch.
  • The intestine’s absorbing qualities may have increased beyond expectations
  • Restriction decreases due to band slippage

 

In most of the above cases, the best solution is restoring an environment allowing proper weight loss by reconstruction of the anatomy’s shape during the first bariatric procedure Dilated, stretched or enlarged pouches can be subject to a re-trimming. This kind of fix requires a band placed around a dilated gastric bypass outlet or making the stoma small as well. In a vertical banded gastro surgery. Previously, it was suggested to re-staple any deteriorated staple lines of gastroplasty procedures; but because of high rates of long term failure for gastroplasty procedures, it has been recommended that these should be converted to a different bariatric surgical procedure, usually a gastric bypass surgery.

Sometimes bariatric weight loss surgical procedures simply do not meet what a particular patient’s metabolism needs.

Aside from the detailed processes involving any type of bariatric weight loss surgery, they all have common goals: losing weight, avoid gaining back any weight lost as to become overweight again and providing a healthy lifestyle during the rest of the patient’s lifetime. All of this means that the success is measured beyond eating properly. A person’s metabolism influences weight loss and weight maintenance, and any failure of this sorts is considered a Metabolic Failure. Corrective surgery attempts to return the anatomy back to its previous shape, the correction of metabolic failure implies a patient’s conversion through a kind of bariatric weight loss procedure more metabolically active; for example converting a Gastric Bypass (also known as RNY) to a Duodenal Switch (or DS), as opposite to just re-trimming the gastric pouch.

  • Weight loss and comorbidities (also known as polypathy).

The failure to heal or stop any illness or conditions after a weight loss procedure is also a much-recurred reason to consider undergoing a revision or conversion bariatric surgical procedure. The unsatisfactory resolution of illnesses is normally related to factors that cause metabolic failure, thus resulting in insufficient weight loss. A condition displaying metabolism failure and other comorbidities need a conversion of the failed bariatric surgery towards an improved metabolic activity end result of a surgery.

  • Medical Complications.

As with many other kinds of surgeries and also due to the differences in biology in patients, sometimes an individual presents medical complications due to bariatric weight loss surgery, they must then undergo Revision Bariatric Surgery. In most cases, the medical complications addressed with a revision surgery will be treated pretty much in the way previously discussed (above) mechanical and metabolic failure; others may be apt for reversal of the first-time surgery while preserving weight-loss. Some of the medical conditions subject to revision surgery include:

  • Anemia (iron, thiamine and other minerals and vitamin deficiency)
  • Malnutrition
  • Metabolic bone disease
  • Severe malabsorption
  • Severe dumping syndrome
  • Stricture
  • Ulcer

Laparascopic Banding / Lap Band Revision Surgery as a Remedy

The possibility of Lap Band failure due to band slippage -leading to a slow chronic condition or in need of immediate attention- requires the patient to go through emergency surgery. When the lap band is not working the way it is meant to, the issue may be solved by removing the Lap Band, repositioning the Lap Band or replacing it altogether. Removing the band will -of course- take the patient back to potential weight gain.

Another complication derived from Lap Band Surgery is Lap Band erosion happening for a number of reasons from not enough blood flow into the part of the stomach where the Lap Band is placed to friction in this same area; the band becomes ineffective and weight is regained; some of lap band erosion symptoms is blood vomit, and another symptom is an infection around the port’s side. Because of this erosion, saliva keeps leaking through overtures in the stomach and flows into the Lap Band tubing, which causes tissue under the skin of the Lap Band port to become infected. As told, the band removal leaves the patient in a condition as if he hadn’t been through weight loss surgery with, of course, weight regain. So it is recommended that Lap Band erosions receive treatment in order to convert the process into Vertical Sleeve Gastrectomy (VSG), Duodenal Switch (DS) or Gastric Bypass surgery. Considering a portion of the stomach may be weakened, prone to further leakage, all of these procedures may be completed with some trimming of the affected area.

Lap Band surgery still can fail for a number of different reasons, thus requiring Revision Bariatric Surgery. With Lap Band being a restrictive weight loss surgery, some patients’ bodies’ metabolism is not proper to help weight loss through a Lap Band procedure. Other cases regard patients not being able to change their eating habits the way it should be in order to embark in a successful process and, as a consequence, the usual weight gain is brought back. Failed attempts at Lap Band surgery can be converted to other kind of weight loss procedure, considering that those surgeries more likely to succeed are the ones which go beyond restrictive weight loss surgery into turning the body into a more metabolically active organism. For patient conversion from a Lap Band failure into Gastric Bypass Surgery or Gastric Sleeve, there are risks of leak development so an experienced revision surgeon is required.

Finally, for individuals looking no further than restrictive bariatric weight loss surgery, Vertical Sleeve Gastrectomy (VSG) is their option. Vertical Sleeve Gastrectomy remains limited to the patients’ metabolism and the metabolic activity of surgery in itself. But VSG produces better long-term results than Lap Band. Gastric Bypass and Duodenal Switch (DS) both provide the patient of a metabolic process able to cause weight loss besides restriction. Patients subject to Gastric Bypass or Duodenal Switch are subject of weight loss advantages beyond those the Lap Band procedure offers.

Bariatric Gastric Bypass (RNY) Revision Surgery

  • Roux-en-Y Gastric Bypasss.

There are two main reasons for Bariatric Gastric Bypass (RNY) patients to seek for Revision Weight Loss Surgery: 1) A fail to lose a proper weight quantity or regaining weight, 2) medical complications. Gastric Bypass failures are produced by metabolic or mechanical causes; and patient’s eating behavior factor shouldn’t be ruled out either; as a matter of fact, eating habits are immediately considered while assessing weight loss failure after undergoing a Gastric Bypass process, and patients are asked to keep a food intake diary. Most people are shocked when they realize the high calories count they consume per day. The food diary is a pretty helpful tool able to provide us of a detailed picture of an individual’s food consumption. When a patient does not stick to the diet and/or eating habits established after undergoing a surgery, then the next step in this process is getting back on track.

The next possible scenarios are:

  • Patient DOES get back on track into his/her food consumption regime.
  • Patient does get back on track to proper diet and / or eating habits but keeps being not successful at weight loss.
  • Patient will not return to proper diet and / or proper eating habits, which could be seen as non-compliance from the patient’s side but not necessarily

We should consider the reasons causing any patient resorting to a maladaptive or improper eating behavior. Patients with an anastomotic stricture may slip into a “soft-calorie syndrome” while going through a phase of tolerating only soft foods without vomiting. It is also important to define compliance terms after Gastric Bypass, regarding what from then on is considered “proper eating”, which in reality is a completely different pattern of food intake for most human beings that haven’t had any weight loss surgery. Some individuals haven’t exactly the personality frame to take on this part of a new lifestyle albeit being ‘helped’ with a rather smaller gastric pouch, even though character not necessarily contributes to this kind of problem.

These are some of the mechanical reasons that could drive Gastric Bypass into failure:

  • Gastrogastric fistula.
  • Pouch dilation.
  • Anastomotic dilation.

 

When a reduced stomach pouch grows back, reconnecting to the bypassed stomach, a gastrogastric fistula is formed. This may happen due to a pouch leak, in which the local inflammation derived from the leak can disrupt the staple line in the already bypassed stomach. But gastrogastric fistula is usually produced by a less immediate process. Anyway, the gastrogastric fistula is related to food passing from the pouch to a bypassed stomach, thus reversing the Gastric Bypass. To restore the previously-set Gastric Bypass anatomy, a closure of the fistula is necessary through Revision surgery.

When we have a condition presenting a stomach pouch stretching out and enlarging, we are talking about pouch dilation; and when the connection between the intestine and the stomach pouch is stretched out, we have anastomotic dilation. Any of these two scenarios make the patient prone to overeating, ingesting quantities beyond required to remain satisfied. A pouch re-trimming would be considered as a proper approach to treat pouch dilation. And an enlarged anastomotic connection by dilation should be treated via endoscopic fixation or surgical banding. Both procedures goal is to restore the end anatomy after the original Gastric Bypass operation before stretching. There’s also the option of a paradigm shift, undergoing a conversion to a more metabolically active procedure like a Duodenal Switch and other VSG based surgical procedures, recommended if the patient’s Gastric Bypass goes under complications due to nutrient malabsorptive issues, like anemia and osteoporosis.

After Gastric Bypass, the best and definitive revision surgery for inadequate weight loss or regain is a conversion from Gastric Bypass to Duodenal Switch. Maladaptive eating patterns and metabolic failure are both addressed with this process, which in most cases can be done laparoscopically, through proper stomach function becomes a potential concern after this procedure, as an already bypassed stomach is back in use; but an “awaken” stomach working again is usually not a problem. But sometimes, excess of scar tissue makes it unsafe to re-connect the bypassed stomach to the gastric pouch. A patient’s satisfying tolerance to protein and calcium metabolism represents a proper option for the process known as Scopinaro-type Biliopancreatic Diversion.

The revision from a gastric bypass to a Duodenal Switch is a very complicated procedure that entails reversing the bypass before commencing with the DS. Only a handful of surgeons worldwide offer this complex and risky procedure.

Other medical complications to a Gastric Bypass are stricture, marginal ulcer and severe dumping syndrome. A conservative treatment is recommended for any of these conditions; but when such a treatment fails, Revision Surgery is an option. Both stricture and ulcer treatment recur to a re-section of the connection between the intestine and the pouch which has been ulcerated or strictured. Conversion to VSG-based procedure is also an option, since both marginal ulcer and stricture are considered conditions arising from the Gastric Bypass’ intrinsic physiology. Vertical Sleeve Surgery is also considered for severe dumping, as the Gastric Bypass’ inherent nature results into such condition.

Gastric Bypass is not an option for cases of malnutrition, vitamin malabsorption and mineral malabsorption. Any procedure involving reversal for nutrient malabsorption may go along Revision Surgery as well to convert into a non-malabsorptive weight loss procedure, so patients avoid weight regain possibly resulting from malabsorption reversal.

  • Mini Gastric bypass

Revision Surgery for Mini Gastric Bypass is pretty much the same as with Roux-en-y Gastric Bypass. There’s a potential condition particular of mini Gastric Bypass which is Bile reflux. Concern about bile reflux is more theoretical, so a conversion from Mini Gastric Bypass to Roux-en-Y Gastric Bypass should be enough to take care about bile reflux. This Revision Surgery is not really complicated, since the procedure does not have to interrupt the first connection between the intestine and the stomach pouch.

Vertical Banded Gastroplasty (VBG) Revision Surgery

Weight re-gain and maladaptive eating are reasons why individuals who had been subject to Vertical Banded Gastroplasty (VBG) or most procedures involving “stomach stapling” recur to Revision Weight Loss Surgery. Some previous Vertical Banded Gastroplasty failures may be treated by re-banding and re-stapling procedures; but most of these cases need a more permanent solution enabled by a surgical process that helps them obtain the desired weight loss goals. Diets and food restrictions are not enough when a patient’s body is not losing weight after weight loss surgery, so a more metabolically active weight loss conversion procedure is required. Having been through a stomach-stapling operation such as VBG, converting to a gastric bypass or Duodenal Switch is a recommended option to be performed laparoscopically. VBG patients do not necessarily need their band removed while going through Revision Surgery.

As we have said repeatedly, different patients have different bodies (thus reacting somewhat different to each process) and also there’s an important number of procedures involving stomach stapling, determining every single case should be treated individually as something unique.

Vertical Sleeve Gastrectomy (VSG) Revision Surgery

Even though Vertical Sleeve Gastrectomy (VSG) is one the most effective kind of surgeries regarding weight loss, there are a number of patients not losing enough weight after undergoing this operation, so Revision Weight Loss Surgery is sometimes required in order to obtain the desired weight loss. The following are the two most common beliefs causing VSG surgery failure:

  • For a stretched stomach, undergoing re-sleeving via a Revision Surgery may be enough.
  • In some cases, a gastric bypass or duodenal switch should be performed so patients improve a certain metabolic and/or food malabsorptive aspect of their entire process, thus completing the purpose of a Vertical Sleeve Gastrectomy.

When undergoing the process of a Revision Surgery with the purpose to switch from Vertical Sleeve Gastrectomy to a Duodenal Switch, there is less risk than that of performing the latter as a first-time weight loss surgery, because a completed VSG surgery involves part of the process that the Duodenal Switch surgery requires, thus resulting in a shorter procedure.

Duodenal Switch (DS) Revision Surgery

With weight loss surgery in general being a recently developed series of surgical procedures, we are all becoming more adept at completely understanding and striking the balance between malnutrition and proper weight loss. As of today, about 2% to 5% of patients that have been through Duodenal Switch are possible candidates for Revision Weight Loss Surgery. The number of individuals having to go through Revision Surgery after DS will certainly decrease, though not eradicated entirely. These are usual reasons for Duodenal Switch revision:

  • Excessive weight loss.
  • Inadequate weight loss.
  • Malabsorption / nutritional deficiencies.

Excess weight loss and nutritional deficiencies are conditions that clearly require Revision surgery after Duodenal Switch, and more than often these happen simultaneously. In these cases timing is a factor upon which much of the success of a remedy depends on. With the passing of time, the malabsorptive effect possible after undergoing Duodenal Switch will decrease as the intestine evolves by increasingly improving protein and other nutrients absorption. This means Duodenal Switch revision shouldn’t be considered too early, for patients suffering from malabsorptive complications; conservative therapy is much rather recommended before undergoing Revision surgery. If this time lapse seems interrupted by Revision surgery, then the patient risks excessive weight regain after the intestine increases its full absorptive capacity.

Malabsorptive complications due to Duodenal Switch usually require elongation (adding intestinal length). To attain the desired results in the common limb, elongation can be achieved by using the biliopancreatic limb. For common elongation surgery then the alimentary and common limbs must be elongated, thus providing protein, starch and fat absorption of additional surface area. An increase in fat absorption abilities helps the body’s ability to absorb soluble vitamins such as vitamin D. In fact, the revision procedure treatment after Duodenal Switch surgery will treat both excessive weight loss as well as the patient’s ability to absorb fat soluble vitamins.

Enteroenterostomy, also known as “the kissing X” is the most simple revision surgery procedure able to increase both common and alimentary limbs length by just a single connection to the small intestine. Patients are enabled to keep a certain level of weight loss due to the “neuro-endocrine brake” effect.

Sometimes after the initial weight loss happening by the Duodenal Switch procedure, some patients may experience inadequate weight loss or weight re-gain. Assuming that there have been failed non-surgical weight loss attempts, two theoretical approaches to solve this problem are considered:

  • Reduce the stomach size.
  • Shortening of the common limb’s length

In North America, stomach size reduction seems to achieve better results than common limb length’s shortening, even though results of these revisions may vary.

 

 

Weight Loss Revision Surgery in Mexico

Lap band to gastric sleeve

Lap band to gastric bypass

Lap band to Duodenal Switch

Re Sleeve

Sleeve to gastric bypass

Sleeve to Duodenal Switch

Sleeve Reconstruction

Gastric Bypass Revision

Lap Band over Bypass

Gastric Bypass to Duodenal Switch

Duodenal Switch Revision

VBG to Sleeve

VBG to Gastric Bypass

VBG to Duodenal Switch

Nissen Funduplication to Sleeve

NIssen Funduplication to Gastric Bypass

Nissen Funduplicaiton to Duodenal Switch