What's the problem with doing a revision of a previous WLS procedure or conversion to a Roux-en-Y Gastric Bypass? Will you do this surgery?
Revision surgery is required only when there is a complication related to the primary surgery. Patients must be aware that repeat surgery on the stomach is significantly more difficult than the primary (first time around) operation. This is because the healing process of the previously manipulated stomach or intestinal tissues involves scarring to each other and to nearby organs such as the spleen, liver, and pancreas. Conversion to a RnY-GBP has a much lower success rate than the primary operation.
Generally this scar tissue must be dissected free in order to accomplish the revision operation, and sometimes this dissection to separate the stomach or intestine from nearby organs actually creates injury to these organs. In the case of the spleen, such injury causes bleeding that may only be stopped by removing the spleen. In the case of the liver, dissection of the scar tissue (also called adhesions) can cause substantial bleeding or perhaps leakage of bile, but rarely requires removal of liver tissue. Damage to the pancreas can result in inflammation of the pancreas (called pancreatitis, which can be very dangerous) or leak of pancreatic digestive juices.
The presence of the scar tissue is also likely to have a negative impact on the quality of the stapling or sewing revisions done on the stomach or small intestine. All surgical techniques involving bowel surgery depend on the patient’s intestine to heal appropriately in place after the procedure is accomplished, and the presence of scar tissue in the area of the procedure may impair appropriate healing of the revision or repair that is created. This means that there is a higher chance of a leak (possibly life threatening) or poor function of the new stomach after revision surgery.
In summary, the patient who requires repeat surgery after prior weight loss surgery must know that there is substantially increased difficulty with the actual conduct of the operation, in comparison to the first weight loss procedure. This increased difficulty does not simply mean that the surgery will take longer or the surgeon will work harder – it also means that the risk to life is greater, and the chance of a desirable long term outcome is not as good. Many patients who require additional stomach surgery have lost a great deal of weight since their first operation, and such weight loss does reduce systemic risk somewhat; however improved systemic risk (if present) does not usually outweigh the increased difficulty in the area of the stomach itself.
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