Revisional Surgery

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Revisional surgery means that due to weight regain or complications after previous obesity surgery, a new operation is performed to achieve a better end result with a better quality of life.

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Potential complications after previous obesity surgery

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Potential complications after previous surgery may include the following:

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-  Food regurgitation (dysphagia) or pain during eating

- An ulcer at the junction between stomach and small intestine that does not heal with medication.

- Gastro-gastric fistula. This means that a connection exists between the gastric pouch (reservoir) and the excluded stomach after previous gastric bypass surgery, accompanied by symptoms or weight gain.

- Severe reflux after sleeve gastrectomy that cannot be managed with medication.

- Severe malabsorption. This means that after previous surgery (gastric bypass, Scopinaro,...) very few nutrients are absorbed which in turn causes severe health problems.

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Potential operations

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Potential revisional surgery may include the following:

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- Conversion of a Sleeve gastrectomy to a gastric bypass

- Conversion of a gastric band to a gastric bypass

- Conversion of a Scopinaro to a gastric bypass

- Conversion of a VBG (McLean/Mason) procedure to a gastric bypass

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Preoperative screening

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Because several complications after previous obesity surgery can be associated with severe nutritional deficiencies or maladaptive eating behaviour, a multidisciplinary evaluation and a comprehensive blood test is essential before revisional surgery can be considered. 

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An Upper GI X-ray series (Barium swallow) is often necessary to evaluate the anatomy after previous surgery.

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In some cases, an additional upper GI endoscopy may also be necessary. 

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Potential complications

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Because revisional surgery involves surgery on tissue that has been manipulated during previous surgery, the risk of complications is somewhat increased compared to primary surgery. In the short term, the risk of leakage along the staple line or at the connection between the stomach and small intestine (anastomotic leakage) is slightly increased.

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Hospital stay

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In revisional surgery, the hospital stay depends on the type of operation performed, the complexity of the procedure and the pre-operative conditions. 

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Nutritional advice and physical activity

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The dietician will explain in detail the diet that has to be followed both before the procedure as well as during the hospitalization. An overview of the various postoperative diet phases can be found here.

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In the first weeks it is recommended to stay mobile: walk around sufficiently and resume daily physical activities as much as possible within the limits of potential pain. Heavy exertion should be avoided intially until after the first consultation with the surgeon, 3 weeks after the procedure.

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Alarm Symptoms

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In the case of the following symptoms, you are requested to contact the general practitioner or our department or, if necessary, to go to the emergency department:

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• Severe abdominal pain

• Fever

• Vomiting blood or blood in stool/black stool

• Inability to take in food.

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Follow-up

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After the operation, follow-up is organised with various members of the multidisciplinary team as well as by your general practitioner. Furthermore, lifelong multivitamine supplements need to be taken. In the first year after the operation, a blood test is also performed at regular intervals to detect any deficiencies in minerals and vitamins. Afterwards, an annual bloodtest is required. 

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