Table of Contents
Last review: 21/10/2021. All content on this page is reviewed by a multi-disciplinary team lead by Mr Rishi Singhal.
Specalisits in weight loss revision surgery
As someone who has had a weight loss surgery procedure you’ll know about the risks and benefits of surgery. It is likely that you also know that revisional surgery is more specialist and technically challenging than primary surgery. For this reason, far fewer providers and surgeons have the experience necessary to do these procedures safely and effectively. As the UK’s largest, specialist weight loss surgery clinic we specialise in revisional surgery.
Due to the specialist nature of this work we focus all our revision procedures on a select group of 4 surgeons, all of whom are specialists and do high volume revision work, both privately and in their NHS practice. Read why this is important and read more about our surgeons here.
From this page, we aim to provide all the information you will need to inform yourself about the revision surgery options that are available to you. Our team members are experienced experts in weight loss and are ready to answer your questions and help you decide upon the best option for you
What is weight loss revision surgery?
As more people have weight loss surgery it’s inevitable that more people will need revision surgery. This is the term we use when referring to the surgery that either corrects a problem with the first weight loss (primary) procedure or that converts the primary procedure into something more powerful (possibly a gastric band to gastric bypass revision).
Am I eligible for weight loss revision surgery?
Our guidelines for patient selection are broadly in line with those published by the National Institute for Health and Clinical Excellence (NICE).
Where they differ, it is because the financial pressures that apply in the NHS do not apply with patients who are privately funding their procedure. Where the NHS is concerned, the ‘national health benefit’ of surgery needs to be balanced with the cost. When patients fund their procedure themselves, the cost balance doesn’t apply. This is why the BMI criteria that apply in the NHS will be higher than those that apply when a patient opts for a private procedure. You are eligible for revision surgery with us when:
- You have a body mass index in excess of 35 (this limit may be reduced for those with type 2 diabetes and those with Asian/African ethnicity – due to increased Diabetes risk), you have attempted to work with your primary weight loss procedure and you are gaining weight, or
- You have a body mass index above 30 and you are experiencing a complication with your primary procedure that necessitates surgical revision for safety reasons.
Before considering surgery for anyone we would need to establish that you have made every effort to succeed with your primary procedure and that the potential to get this procedure working without the need for more surgery has been exhausted. This is most common for gastric band patients. We occasionally find that incorrect adjustment of the gastric band, or poor aftercare, was the reason for failure. The band or access port may also be leaking given the impression of failure, when in fact the problem is mechanical (and not with the patient). In cases like this, we would always attempt to get the band working as it should before undertaking more surgery.
When discussing the prospects of revision surgery with you, we are motivated by 3 things:
that your procedure can and will be undertaken safely.
That you can expect to lose weight with the revision procedure
This is particularly important for people already living with weight-related health problems.
A rigorous approach to pre-operative assessment and preparation is important for all weight loss surgery, regardless of type, and it’s something we pay extra attention to at Healthier Weight.
We regard it as more important for revision surgery than for primary procedures. There are two reasons for for this:
- The incidence rates for complications are higher with revision surgery, and
- Having had one weight loss procedure fail, we want to make sure that the risk of a second failure are minimised. This means we’ll pay added attention to your capability to cope with the post-operative diet and eating regime required for success.
Our approach is motivated entirely by our commitment to seeing patients succeed. We want to avoid the need for any further surgery in the future if at all possible.
Here are the steps we take to maximise your prospects of success:
Initial telephone consultation with a revision surgery expert within our team
Face to face consultation with a specialist surgeon. We limit revision surgery to only those surgeons who are most experienced in it. This is proven to reduce risk. See our revision surgery team here
Diagnostic testing as necessary to diagnose the reason you are experiencing problems with your primary procedure. This would most commonly involve a barium x-ray. See information on diagnostic testing here
Review by our internal multidisciplinary team, including an independent surgeon and members of our clinical management team. Independent dietitians and psychologists are involved in this process.
Detailed information on the procedure and the diet, eating and exercise regime required for success
Pre-operative assessment at the hospital where your surgery will take place
Pre-operative telephone call by Healthier Weight’s nursing team to ensure you are fully prepared
Weight Loss Revision diagnostic testing
We use a range of diagnostic tests in order to accurately diagnose and inform our revision surgery decisions. They include the following:
Clinic reviews with our nursing team – This is where diagnosis usually begins, and in all cases for gastric band patients. If a patient has a suspected leak from their band the diagnostic process will involve a number of regular clinic visits for volume checks. X-rays are notoriously poor for diagnosing port leaks.
Barium x-ray – This will always be needed for patients who have a failing bypass or sleeve procedure. On occasion we will use it for band patients too. This is in cases where a slippage or leak from the band or tubing (not the access port) is suspected.
Gastroscopy – This is a more invasive investigation that involved placing a camera into the oesophagus (gullet) and stomach through the mouth. This procedure is done under sedation so is relatively painless. It’s very rare that a gastroscopy would be needed. The most common cause would be to diagnose a suspected erosion in a gastric band patient.
Gastric band revision surgery
Most patients seeking revision surgery are those who have, or have had, a gastric band implanted. This is mainly because more gastric band procedures have been done than any other type of private weight loss procedure.
On this page you’ll find a series of links to every cause of band revision there is, so we hope you’ll find exactly what you need:
When you have the information you need please call our team in order to schedule your surgeon consultation. This will be free of charge and without obligation.
Alternatively, if you didn’t find the answer to your question, please call us on 0121 281 0973 or arrange an expert call by clicking the pink button.
Gastric bypass revision surgery
With all weight loss surgery procedures most patients can expect to regain some of weight they have lost over a period of time. They might lose weight for 4-5 years and then see a slow regain in the years ahead, but not nearly to the weight they started. The gastric bypass is no different.
Unlike the other procedures, the revision surgery options are not as good for bypass patients as they are for those with gastric bands and gastric sleeves. With band and sleeve we can revise to the gastric bypass. For obvious reasons that option doesn’t exist here. Gastric bypass patients who are regaining weight do have options though, and these are shown below.
Please use the links to find more information on each option.
We’ve listed a medical weight loss programme as the best option for bypass patients experiencing weight regain. This is because it is a safer option than surgery and with some of the new weight loss medicines it is possible to achieve baseline weight loss in the 10-15% range*. This is close to what can be expected from revision surgery. Before deciding to have revisional bypass surgery we encourage all patients to explore a medical weight loss programme first.
After Medical Weight Loss Programme we have ranked the surgical options in order of our preference, based on what we believe to be the best available published data. A recent publication by Tran et al and published in Obesity Surgery contained a systematic review of the options and drew conclusions on the weight loss and complication profile of each. We’ve used this publication to inform our rankings.
As you will have read elsewhere on this site, revision surgery carries a higher level of risk than primary surgery. This is because your first procedure will have left scar tissue around the organs that reside in the stomach, including the stomach.
In all bypass revision cases, it will be necessary to carry out a barium x-ray first. This will enable us to fully understand the reason your bypass is no longer working for you.
Call us today on 0800 313 4618 to schedule your free of charge surgeon consultation or click the pink button to arrange a call with one of our experts.
Gastric sleeve revision surgery
As with all weight loss procedures, including sleeve, we expect a period of rapid weight loss over the first few years after surgery to be followed by a long period during which some weight will be regained. Most studies show this pattern for all procedures. Of course, there are exceptions, but this would be the norm.
In the case of the sleeve, there can be various reasons why weight is regained. In cases of slow regain we anticipate this is due to the body adjusting to the smaller stomach, but in cases where weight regain is faster it will usually be due to the sleeved stomach dilating (stretching), and the benefit of the tight sleeve being lost. The stomach is an amazing organ. Over time it will stretch and this is more likely when patients are unable to follow the post-operative diet regime, and eat portions that are too big. In extreme cases, the stomach can get back to a size similar to what it was originally. Of course, it may also be the case that the sleeve was large in the first place. When surgeons do a sleeve procedure they will measure the size of the new stomach using a device called a bougie. This is placed into the stomach through the mouth and they use it as a guide when sizing the smaller ‘sleeve’ stomach. There are different sizes of bougie and the size used is down to surgeon preference. It means some people will have had a bigger sleeve from day one.
Revision surgery patients must accept that the risk of experiencing a complication is higher than for primary surgery. This is because the stomach would have been disturbed with the primary procedure and adhesions (scar tissue) would have been left. This is normal but it does mean revisional surgery is a little less predictable. In experienced hands, these increased risks are minimised.
The cost of weight loss revision surgery
It is important to contact us to get a written quotation so that you fully understand what is included. For revisional surgery, more so than primary, prices can vary as the surgery is inherently more complex.
Prices will vary slightly to take account of local variations in pricing. Your written quotation will confirm the price payable. Please note: finance plans are not available for band revisions.
The price for your procedure may increase if your expected theatre time, length of hospital stay, need for high dependency unit care, diagnostic testing requirements, take home medication, post op bloods/scans are outside of the norm. As you can see there are many variables. Your surgery will advise us of any increased requirements in advance of you going ahead so you can be confident that you’ll know the anticipated price before you proceed.
Your theatre time for revisional surgery will always be longer than for primary procedure. The prices we change reflect this. As such revision surgery prices are not comparable to primary prices, e.g. a revision gastric bypass will always require a higher price than primary gastric bypass
Mr Rishi Singhal says
As a bariatric surgeon, revision surgery is the surgery I enjoy most. We never know quite what to expect as it’s impossible to know what state the abdomen will be in following the primary procedure. I see an increasing number of patients in clinic who want revision and I expect the trend to continue. Thorough pre-operative assessment, focusing surgery on only those surgeons who do a lot of cases and paying careful attention to outcomes are important attributes of the Healthier Weight programme.