Revision of Gastric Bypass Provides a Second Chance

Posted on: 17th Feb, 2022


Gastric bypass (Roux en Y gastric bypass or RYGB) was a great procedure for many people. But time can lead to weight regain, and for some individuals, many pounds are regained over the years. If it has been 10, 20, or even 30 years since the gastric bypass procedure, what can be done?

Today there is a very useful revision that can be done safely and successfully. In fact, in published series worldwide, including our own, of revising gastric bypass in this way has proven to be one of the most successful surgical procedures around. Here’s why a revision of gastric bypass provides a second chance.

Past Revision Procedures

The average person in our series lost 70 pounds in the first six months after gastric bypass revision, but some lost as many as 150 pounds. This occurs even though these individuals already had gastric bypass surgery many years ago and were often told there was nothing more that could be done.

So how does this work? Procedures tried over the course of decades have had a mixed track record, so what makes this newer revision procedure different? Let us start by examining how gastric bypass works and what strategies have been employed to revise the procedure when weight gain occurs.

Today we know that gastric bypass acts via a hormonal mechanism. A smaller contribution may come from restricting the food we eat by creating a small stomach pouch, but mostly it is the hormones that “re-set” the body weight set point, metabolism, blood sugars, and fat storage.

In one revision strategy, surgeons in the past attempted a strategy to create more “restriction.” This means tightening the stomach pouch, making it smaller, or shrinking the outlet from the stomach pouch. Several strategies have been employed, including using stitches or sutures to shrink the stomach pouch, placing a band around the stomach pouch, and using endoscopy tools to place stitches on the inside of the stomach pouch. All of these were predicated on the idea that we are gaining weight because we are eating too many calories and too much food. That is not the case for more than a tiny of people who regained their weight.

The other strategies have involved revising the bypass portion, meaning the intestinal portion of the procedure, so that it is more powerful and jumpstarts the weight loss. Surgeons and programs often referred to this as a malabsorption strategy, erroneously thinking that we lose weight because we are sneaking calories past the body and pooping them out before our intestines can absorb them. Nonetheless, the strategies had a great deal more success, not because of malabsorption, but because of the hormonal changes they create that resets metabolism and body weight.

It is all about the regulatory hormones.

Revision Procedures Today

As the science of metabolic hormones has improved, we have gained a greater understanding of the specific tissues where the hormones come from and how best to optimize them. And while we have a long way to go in our understanding, the improved science has enabled us to more specifically target the tissues that can have the maximum benefit for weight loss and reversing or preventing diabetes.

Today, the revision procedure is considered most successful when it is the least invasive, has the fewest side effects, and is the most effective. We aim for simple, safe, and successful in delivering weight loss results. The optimal strategy today involves using the small incisions – “laparoscopy” – such that the patient will wake up and recover with just five small Band-Aids but no big incisions. Then, we disconnect the connection that was previously made at the junction of the “Y” and then add significant length to the arm of the intestine known as the pancreaticoduodenectomy (PD) limb. We then reconnect and re-create the nice new bypass. What is different is that now we have a much longer PD limb that is the most important area for hormone secretion. The absence of food substrate tickling the intestinal lining is precisely what causes the favorable shift in hormones resulting in lower body weight, lower blood sugar, lower triglycerides, and less fat storage. That is precisely what occurs here with this revision.

Over the years and with a good deal of experience, this revision strategy has been honed to a 45-minute precision procedure and has become safer, simpler, easier, and highly effective. So, if you or someone you love has had gastric bypass (RYGB), gained weight back and been told there is nothing that can be done, it is time to do your homework. 

A revision of gastric bypass is a second chance at life, improved health, more energy, and a healthy body weight. Contact the Sasse Surgical team today to learn more.

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