Proximal Gastric Bypass, commonly known simply as gastric bypass, is the most often performed weight-loss surgery in the United States. Should Proximal Gastric Bypass not have the desired results — either you regain weight or do not lose as much weight as projected — then an option is a Distal Gastric Bypass Revision Surgery. The question is, is revising a proximal gastric bypass to a distal gastric bypass your best option?
Understanding the Gastric Bypass Surgery
Gastric bypass is a bariatric surgery procedure in which the stomach is divided into two compartments. The upper part of the stomach, or the pouch, is the smaller part. The small bowel is split and raised to the upper stomach where an opening is made between the pouch and the small bowel. This opening is called a stoma. The stoma size holds food in the pouch, and the patient feels full for hours on a small portion of food. The size of the stoma is critical because one that is too large will not allow the patient to feel full and one that is too small can cause heartburn, nausea or vomiting.
Proximal to Distal Gastric Bypass Revision
Distal Gastric Bypass is when more than 120 inches of the intestine is bypassed instead of the eighteen to forty inches that is bypassed in the Proximal Gastric Bypass. If more of the intestine is bypassed then weight is lost through the process of malabsorption. What this simply means is that there is less intestine to absorb food, calories, and nutrients.
The amount of small bowel that is bypassed will regulate the amount of fat and complex carbohydrates that can be absorbed. After this surgery, patients do not absorb fat as efficiently. This will change over time, and the patient will be able to absorb more fat.
Is Revision Gastric Bypass Surgery Successful?
I asked bariatric surgeons on the ASMB group on LinkedIn for their perspectives on the proximal to distal gastric bypass revision in patients whom have not lost enough weight or whom have had weight regain. Of those surgeons who chose to respond, none agreed with this approach to gastric bypass surgery revision:
Esteban Varela MD, MPH, MBA, FACS Lengthening of the biliopancreatic limb, not the alimentary limb, is the key step during revisional Roux-en-Y gastric bypass for weight regain and diabetes recurrence. He references this study on pubmed.
TUGRUL DEMİREL, M.D. No any such revision will give the QOLbased efficacy of Duodenal Switch: Taking BP limb distally will result only with more bad smell of stool and gas but not any expected weight loss; whereas forming a Switch like long BP limb will result severe diarrhea and inevitable weight loss which will need a greater revision. If you will not do a Duodenal Switch for a previously high BMI patient (>45 kg/m2) my recommendation is Don’t Touch just refer to a DS Surgeon.
Oscar Alfonso Varela Zobra No. For weight regain in a gastric bypass it is better to reduce the size of the gastric pouch and the diameter of the gastro-yeyunal anastomosis.
These perspectives don’t replace a medical consult but the information can help you to have a more productive conversation with your bariatric surgeon.
Check Your Eating Habits
Patients often gain weight after gastric bypass surgery because they fall back into old eating habits. Revisit the bariatric diet and pouch rules. The Gastric Bypass Pouch Rules developed by the “father of gastric bypass surgery” Dr. E. E. Mason are said to be the key to permanent weight loss. The gastric bypass surgery patient must also be careful about skipping meals, snacking, and eating foods that are high in carbohydrates. Before opting for any gastric bypass revision surgery, you might want to consult with a bariatric nutritionist to modify your habits and general approach to eating healthy.
You also might try a “Back on Track” program offered by well-known bariatric patients/educators Sandi Henderson at WLS Success Matters or Colleen Cook at Bariatric Support Centers International. This program is designed for those who have reached an extended plateau or have regained weight. And please be sure to read my interviews with Sandi Henderson and Colleen Cook on MyBariatricLife!
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