The Revision Process at NYU Winthrop Surgical Associates
The bariatric surgeons at NYU Winthrop Surgical Associates are experts in revisional bariatric surgery, a specialized surgical skill for fixing previously unsuccessful primary bariatric surgeries, or cases in which patients have regained significant excess weight. The most commonly performed secondary bariatric procedures involves the removal of a gastric band followed by performing a gastric sleeve or gastric bypass procedure. Technically, this is not a revision, but a conversion procedure. Between 20 and 30% of all band patients will experience either less than ideal weight loss, complications, or weight regain, necessitating the removal of the band and subsequent conversion to a more effective, stapled procedure.
Less frequently, when a gastric sleeve or gastric bypass fails, this is considered a revision. Since these procedures are not reversible, specialized techniques are used to improve patient outcomes and get them back on track to weight loss and disease resolution. Because of the unique nature of conversions and revisions, we have an established process to ensure that the secondary bariatric procedure is both safe and effective.
Of course, before embarking on a secondary bariatric procedure, we wish to ensure that the lack of weight loss or weight regain is not caused by something that can be handled without surgery. For patients who do require a secondary bariatric surgery, we follow the steps below:
Step 1 – The Seminar
Band-to-sleeve or band-to-bypass patients can either review the online seminar or can attend an in-person seminar, as is our normal practice for new bariatric patients. Since the band does not change any part of the normal gastrointestinal anatomy, we simply want our patients to learn more about staple procedures. This can be achieved either in person or online.
Revision patients (sleeve-to-bypass or gastric bypass revising to another procedure) must attend an in-person seminar. This is so that we can adequately answer their questions and specific concerns, something that can only be done in person. Follow-up questions can be addressed to our practice manager and bariatric coordinator, Karen Norowski. If patients are good candidates for a secondary procedure, they will move on to Step 2 below.
Step 2 – Nutritional
Revisional patients will be required to attend nutrition appointments with our in-house nutritionist. They will then have labs, upper GI evaluation and endoscopy, and see their surgeon to determine if they are a candidate for revisional surgery.
Step 3 – Surgery
After a consultation with one of our surgeons, and the mutual decision that a conversion or revision is appropriate, we will move on to surgery. The surgery being performed will largely depend on the problem, the patient’s current health status, and the realistic results we ultimately wish to achieve. It is important to note that revisional bariatric procedures are inherently more complicated than the primary surgery. Therefore, the patient should closely follow their surgeon’s directions preoperatively and postoperatively.
A conversion or revision procedure may be exactly what is needed to help the patient get past a setback from their primary procedure. We require more pre-operative testing for revisional procedures, as they do come with additional surgical risk. However, if you are experiencing any complications or less than ideal results from your primary bariatric procedure, we encourage you to visit with us to learn more about your options for correcting it.