Gastric bypass or Roux-en Y procedures is among the most commonly performed bariatric surgery procedures for management of obesity. It is an effective method that causes excessive weight loss over 12-18 months; most of the patients who undergo this procedure come to normal weight by 2 years. Gastric bypass is generally well tolerated and successful however; small numbers of people who undergo gastric by pass surgery either fail to lose weight or develop complications. This failure to lose weight or getting complications after the procedure is called gastric bypass failure. There are several reasons for gastric by pass failure; the most common causes are,

1. Failure to lose excessive weight
2. Regain of weight after initial weight loss
3. Complication both medical and surgical

Failure to lose excessive weight

Failure to lose sufficient weight after gastric bypass surgery is multifactorial. The most common reason for failure to lose weight is not adhering to dietary advice. Patient ignore dietary advice after gastric by pass and consumes high caloric foods on daily basis. This leads to weight loss failure. Other causes for failure to lose weight include dilatation of pouch which leads to increased consumption of foods. In order to work out the cause for weight loss failure, patient should make a diary for daily eating and note what he or she eats daily; this will show if patient is not following dietary advice. Failure to lose weight after gastric by pass is an indication for revision bariatric surgery to lose weight effectively.

Regain of weight after initial weight loss

Some patients who undergo gastric by pass surgery have initial weight loss which continues for several months but they regain weight over subsequent months. The reason may be change in dietary pattern or dilatation of stomach pouch due to which patients eat more food to get satiety. Both the reason lead to gastric by pass failure and patient needs revision bariatric surgery to achieve ideal weight.

Complications of surgery-medical and surgical

Some patients develop either medical or surgical complications after gastric by pass and need revision bariatric surgery to correct these complications. Surgical complications are minimal at dedicated bariatric surgery centers where experienced surgeons perform bariatric surgery. The complications that cause gastric by pass failure and make revision bariatric procedure necessary are given below,

• Surgical or anatomical complications are those in which either gut anastmosis is narrowed or stomach pouch is dilated. These complications can only be corrected by performing revision bariatric surgery.
• Medical complications are those in which patient develop symptoms of diarrhea, ulcers, solid intolerance, dumping syndrome, anemia, severe constipation and severe gastro-esophageal reflux disease. If these symptoms become intolerable then only option to correct them is revision bariatric surgery.

REVISION BARIATRIC SURGERY: A GOOD OPTION TO CORRECT GASTRIC BY PASS FAILURE

Patients who fail to lose weight, regain weight after initial weight loss or develop complications after gastric by pass surgery need revision bariatric surgery to lose weight and get rid of complications. Revision bariatric surgery procedure is chosen depending upon the cause of failure of weight loss surgery. Following revision bariatric surgery procedures are extremely effective to for losing weight after gastric by pass failure occurs,
Lap-band or laparoscopic gastric banding

This procedure is an ideal choice for patients in which initial weigh loss occurs after gastric by pass but they regain weight after few months. Lap-band surgery is also effective in patients in which gastric pouch dilatation is reason for gastric by pass failure. In lap-band surgery, a small adjustable silicon band is placed at upper end of the stomach to reduce stomach size. This procedure is performed with laparoscope by small incisions on the abdomen that heal quickly. If performed in a properly selected person, results in excessive weight loss over months.

Duodenal switch surgery

Duodenal switch surgery is an excellent revision bariatric surgery procedure for majority of patients who have gastric by pass failure. In this procedure, a small banana shaped stomach is created and two parallel limbs of small intestine are formed. Food passes through a separate channel and juices of liver and pancreas are drained through other channel. This procedure not allows mixing of food with digestive juices so, little absorption of ingested food and patient loses weight quickly. Duodenal switch surgery is preformed in following cases of gastric by pass failure,

• Failure to lose weight after gastric b pass
• Regain of weight after initial weight loss
• Intractable gastro-esophageal reflux after gastric bypass
• Severe nausea and vomiting associated with gastric bypass surgery
• Marginal ulcer
• Dumping syndrome

Revision bariatric surgery is although difficult and more risky than primary bariatric surgery procedures but if performed by experienced surgeon carries little risk of complications. Dedicated bariatric surgery hospitals are good choice for such kind of revision bariatric surgery as these are equipped with all the facilities for safe surgery including experienced surgeons. Surgery centers that claim to be cheap in the market are not suitable for revision bariatric surgery procedures and complicate the matter further.

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