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Laparoscopic Revisional Surgery

Although the current group of weight loss surgeries is safe and effective for weight loss, a small number of patients may require a revision of their procedure. The surgeons at Brigham and Women's Center for Metabolic and Bariatric Surgery (CMBS) are very experienced with these operations and have one of the largest experiences in the region. At CMBS, most of these operations are performed laparoscopically.

Revision surgeries are complicated. There are many reasons for a patient to desire or require another operation. Every case is unique and requires an individual evaluation. Patients may require additional surgery to correct a problem of the original operation such as a band slippage or breakdown of their gastric bypass staple line. Patients may consider another operation if their original procedure did not achieve the desired weight loss or after gaining back some or most of the weight they lost. Revision operations can be placed into three categories:

  1. Reversals – Taking down the original operation and restoring the normal gastrointestinal anatomy. These includes simpler procedures such as removing a gastric band and more complex ones such as reversing a gastric bypass. The sleeve gastrectomy is not reversible.
  2. Conversions – Switching one operation for another, such as removing a gastric band and then performing a gastric bypass or sleeve gastrectomy. Another example would be to convert a sleeve gastrectomy to a gastric bypass.
  3. Revisions - Modifying or repairing an operation that has an abnormality such as repositioning a gastric band after a slippage or restoring a gastric bypass pouch to correct a staple line breakage or pouch stretching.

Most revision procedures are complex. The likelihood for complications is greater than it was for the original operation. Patients being considered for corrective surgery for weight loss failure or weight regain will be carefully evaluated prior to being offered another operation. Additionally, if the weight loss failure is determined to be due to poor behavior and not a consequence of an anatomic defect of the original operative procedure, revision surgery would not be considered likely to be beneficial and therefore not offered.


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