For many patients, a single operation to treat obesity is sufficient to produce durable, long-term weight loss without complications. For some patients, however, a bariatric procedure may yield less-than-optimal results, either through insufficient weight loss, inadequate resolution of co-morbidities, or by medical complications related to surgery.

 

The bariatric surgeons at Alvarado Hospital offer a comprehensive revision program to help you recapture your weight-loss goals. Patients all across the country have trusted the experience of our multi-disciplinary team of board-certified surgeons, nurses, nutritionists and therapists. Our comprehensive follow-up care program aids in long-term weight-loss success. We fully understand the challenges associated with obesity and offer several solutions tailored to meet your specific weight-loss struggle.

 

Alvarado Hospital offers traditional and pioneering revision procedures performed by highly experienced surgeons.

 

 

If, despite a gastric bypass or similar If, despite a gastric bypass or similar  weight-loss surgery, your weight has returned to a morbidly obese level (90 pounds overweight or a BMI over 35), the gastric band may offer new hope. To be a candidate for this innovative procedure, we must first fully comprehend why the weight has been regained.

 

Candidates: In most cases, eating behavior after the original gastric bypass is studied and corrected with the help of a clinical psychologist and dietitian. Additionally, an X-ray (gastrograffin swallow) or endoscopy (scope procedure) is performed to confirm whether the stomach pouch has been “stretched,” thereby predisposing to the current weight gain.

 

Procedure: During a band-over-bypass procedure, our highly trained specialists place an adjustable band over the previously failed weight-loss surgery. The objective is to position the band around the highest part of the stomach and restrict the ability to overeat.

 

After Surgery: For band-over-bypass  patients, a one-night stay in the hospital is usually all that is needed. Most patients take a week or two to recover prior to returning to work. Physical activity is initially restricted and heavy lifting is not advisable for one month. To maximize your success and help the healing process, dietary guidelines and regular follow-up appointments with your physician are an expectation.

 

Risks: Currently, few band-over-bypass procedures have  been done in the United States, but the results are impressive as long as the patients are well prepared and supported. The risks are considered similar to a primary open gastric bypass. Side effects, although not common, include reflux, band erosion, leakage or band slippage.

 

Insurance: Alvarado Hospital is one of the pioneers in  this field. However, as there are no long-term published result to date, insurance companies will require certain criteria are met.

 

 

Alvarado was the first hospital in the San Diego area to offer the new incision-less procedure called StomaphyX. The procedure uses a simple scope through your mouth to tighten the stomach pouch, avoiding many of the risks associated with traditional revisional surgery. The StomaphyX procedure can give a second chance to patients who have regained weight after gastric bypass. Benefits of the StomaphyX procedure include no incisions and you are home the same day.

 

StomaphyX is an incision-free, outpatient procedure only performed by a few physicians nationwide. Unlike other revisions, StomaphyX is performed through the mouth. While under anesthesia, a flexible tube is gently lowered from the mouth down to the stomach.

 

Using an endoscope, the surgeon is able to attain an illuminated, magnified view of the stomach. Small sections of the stomach wall are folded inward like pleats and “secured” in place with a suture-like fastener. The number of pleats varies with the needs of each patient. The stomach volume can be reduced up to 80%, requiring less food to fill the stomach.

 

Candidates: If you are regaining weight because your stomach has “stretched out” over recent months or years since gastric bypasss surgery, or if you have never been able to achieve your desired weight despite surgery, then StomaphyX may be the solution for you. There is no minimum weight requirement. However, a physician consultation and simple upper endoscopy is necessary to verify if you are a viable candidate for this specialized procedure.

 

After Surgery: StomaphyX is an outpatient procedure so patients typically return home the same day. Most patients feel well enough to return to work after one day. However, physical activity is restricted for one month. To maximize your success and help the healing process, dietary guidelines and regular follow-up appointments with your physician are a requirement.

 

Risks: Because there are no incisions, there is no scarring and the risk of infection, bleeding and other complications are reduced. Common side effects include a sore throat, slight discomfort in the neck or chest, and “tightness” in the stomach for the first few days. Some patients may take a pain reliever for these symptoms, but most are comfortable without it.

 

Insurance: While the procedure itself is not yet covered by insurance, the endoscopy is sometimes covered and lab tests are typically covered (if post-surgical testing was previously covered).

 

Traditional Revision Procedures

 

Alvarado offers two traditional revision  surgeries. For previous gastric bypass patients, there is the option to redo the bypass procedure. For previous gastric banding patients, we can replace the band with a gastric bypass. The pre-surgical preparations and standard postsurgical recovery expectations are somewhat similar to their primary surgery. However, the risk of complication is higher with any revision surgery. To maximize your success and help the healing process, dietary guidelines and regular follow-up appointments with your physician are an expectation.

 

Candidates: Due to their complexity, these operations are recommended more for patients experiencing difficulty with their primary weight-loss surgery (i.e., inadequate resolution of co-morbidities or medical complications specifically related to the weight-loss surgery). These traditional revision surgeries are not recommended, and often not covered by insurance for simple inadequate weight-loss or recurrent weight-gain reasons.

 

Risks: In the hands of a highly skilled and experienced bariatric surgeon, the results of these operations are generally positive. The previous medical complication is most often corrected and the associated problems resolved. Weight loss, on the other hand, is likely to be less dramatic than it was following the primary operation and should not be the only reason for these types of revision surgeries.

 

Patients also need to understand that traditional revisional bariatric surgery is difficult to perform due to its high complexity and complication rate. Although these procedures seem much like a primary bariatric procedure, they are typically longer operations performed through open incisions with greater blood loss and a higher incidence of leak and infection. The decision regarding these surgeries and your specific case should be thoroughly discussed with your bariatric specialist.