Gastric Bypass Revision Surgery...
Because of the success rate of gastric bypass surgery less than 5% of gastric bypass patients require a revision procedure. However, in some cases, a revision surgery may be appropriate to resolve issues that may have arisen as a result of the initial gastric bypass. These issues include:
The stomach pouch or the connection between the stomach pouch and intestine may stretch over time. This counteracts the feeling of satiety, or fullness, during meals. Over time, this can lead to unwanted weight gain.
Fistula formation: An unusual complication where the small pouch reconnects itself with the disconnected portion of the stomach. This could lead to ulcer formation or weight regain.
Marginal ulcer: Recurring ulcer at the connection of the pouch and intestine (Gastro-jejunostomy). The causes for marginal ulcers include: smoking, significant/ chronic NSAID use, poor quality of blood supply to the intestine. This results in pain at site and narrowing at the site of stomach / intestine connection.
There are several options for gastric bypass revision surgery, all of which Dr. Korman performs laparoscopically. These techniques result in improving either of the two main objectives of the to gastric bypass surgery: portion control (also known as restriction), and malabsorption (fewer calories absorbed by the body). It is also possible to enhance both elements in the same surgery.
Endoscopic Pouch Revision...
Also referred to as the ROSE or Apollo procedure, this option is the most minimally invasive. In order to access the pouch of the stomach, a lighted instrument called an endoscope is placed through the mouth and down the esophagus. Attached to the end of the endoscope is a device that sutures the opening of the stoma to make it more narrow. This restricts the amount that can be eaten at once and creates satiety. Patients are able to return home the day after the ROSE procedure and resume normal activities within a few days. However, follow up care is critical to make sure the stomach diameter does not increase.
Laparoscopic Pouch Reduction...
This technique enhances restriction, a term we use to describe hunger and portion control.
After an initial gastric bypass surgery, the stomach pouch is reduced to approximately the size of an egg (figure 1). Over time, it is possible for it to stretch. This causes a decrease in satiety for the patient (figure 2). Pouch Reduction Surgery reduces the volume of the “stretched” pouch by either stapling and removing the stretched portion of the pouch or by folding in and sewing the lateral edge of the pouch to decrease its volume (figure 3). The approach used is determined at the time of surgery depending on anatomic considerations.
The distal bypass procedure adds an element of malabsorption by short-circuiting the digestive process, which reduces the length of the common channel, where most nutritional absorption occurs. During the initial gastric bypass, the length of the common channel is typically shortened from 800cm to approximately 700cm. The common channel is the length of the intestine where digestion and absorption of nutrients occur. In a distal bypass revision procedure, the common channel is further shortened from 700cm to 400-500cm. This reduces the number of calories that can be absorbed because there is less absorptive length in a shorter common channel. This technique is illustrated in Figure x
Pouch Plication + Distal Bypass...
This surgical technique has been developed by Dr. Korman. With such high success rates of patient success for a large number of years, Dr. Korman also teaches this technique to general surgeons specializing in bariatrics.
When a patient requires gastric bypass revision surgery due to weight regain, Dr. Korman performs this procedure which accomplishes both enhancing the restrictive element and the malabsorptive effect similar to that of a primary gastric bypass. This is done by a combination of reducing pouch size and “short-circuiting” the digestive system to shorten the common channel. In other words, to reduce the absorptive surface of the small intestine.