Revision bariatric surgery refers to different bariatric procedures that are undertaken after any primary weight loss surgery. Depending on the primary surgery there can be several reasons for that but most often its inadequate weight loss or weight regain later on. For instance:

• when results of primary lap-band surgery are unsatisfactory or band is poorly tolerated the band removal with simultaneous gastric bypass or gastric sleeve surgery can be performed.
• when gastric sleeve haven’t given the desired weight loss or patient is suffering from heartburn/GERD then conversion to gastric bypass or mini bypass is possible.
• Severe heartburns/reflux after mini-bypass surgery may require conversion of mini-bypass surgery into standard Roux en-Y bypass surgery.
• for gastric bypass revision we provide Gastric bypass distalization. Distalization means bypassing more small bowel thus shortening the length of small bowel for digestion. We shorten small bowel that receives food down to 3,5-4 meters  by extending the length of biliopancreatic (or bypassed) limb. It leads to partial malabsorption of macronutrients and  changes interaction between gut and brain reducing hunger sensation. We also reduce gastric pouch size if needed.

There is a good reason weight loss surgery patients usually do not have to be disappointed in long term surgical outcomes: good and sustainable weight loss, excellent control of chronic illnesses and improved quality of life. Today, surgery is and remains for a foreseeable future a single effective and accessible method of treatment for morbid obesity. If there would not be surgery those patients would practically have no chance for care.

Nevertheless it can’t be stated that surgery is invariably effective and there is sometimes a gap between surgical outcomes and patients expectations. Weight loss less than expected, weight regain over years, uncomfortable side effects with nutritional issues are problems laying frequently behind dissatisfaction.

We perform 40-50 revision bariatric surgeries per year (250-300 primary procedures). Most of them can be performed safely laparoscopically even after open primary surgery. Revision procedures are always complex implying excellent surgical skills and understanding anatomic and surgical principles that are prerequisite for sustainable weight reduction. Detailed history of weight loss, appetite control, eating patterns and adverse outcomes after primary procedure is mandatory before considering redo surgery to understand what has gone wrong. Additional instrumental investigations like upper gastrointestinal endoscopy and radiography are always used before elaborating definite treatment plan.

Weight loss after revision bariatric surgery is usually slower and smaller than that would be after primary surgery. Usually, a loss of 50% of excess weight patient is having at the moment of secondary surgery can be expected and considered satisfactory.