The Nuts and Bolts of Band Revisional Surgery

Photo by M Clock

You don't always get what you expect.

Take the example of the water temperature on Cape Cod.  If your expectation is that the water should be warm based on your previous ocean experiences, you will be in for a surprise.  The Caribbean it is not, but unto itself it is a beautiful place in so many ways.

The more I thought about writing this post, the more the idea resonated as an increasingly important concept to share.  The more I thought about it, and saw patients this week in the office that this directly applied to, the more I envisioned this post growing substantially in length.

As I have referred to before, one of the 'secrets' of a rip-snorting Blog is that the posts are succinct and bite-sized in their approach.  So....

Let's do this in three parts.  Part one will identify the scope of the problem.  Next will be the process the patient goes through to get the revisional procedure, including the insurance aspects, and I will finish up with Part 3, detailing how we tailor the surgery choice based on the individual patient's needs and presentation.

Part 1

Band revisions are being done a little more commonly these days in our practice.  This stems from a small segment of our Band population having mechanical issues, such as Gastric Prolapse, pouch dilation, esophageal issues non-remedied by extracting fluid from the Band, as well as the rare case of gastric erosion.

Probably the most common reason, though, is lack of weight loss.  This usually has a significant behavioral side (not eating the correct foods the correct way, or lack of consistent exercise, or poor office follow up) but that can be occasionally be exacerbated by other mechanical issues of improper restriction which can 'encourage' maladaptive eating patterns that lead to weight loss plateaus, weight gain, or weight regain.

We commonly deal with these issues on an acute level in follow up, as long as the patient presents for us to offer our assistance and our clinical expertise. However when left unchecked for months or years on a subacute or smoldering level, they can become difficult to overcome.

Even so, both we and the patient's insurance company generally want to see a proven record of a reasonable attempt of usually 2 years of consistent effort at following through on the necessities of aftercare that are stressed repetitively in a multidisciplinary way.

Next up will be a more detailed description on what the patient needs to go through to get their revisional weight loss surgery, including some of the insurance hoops that have become necessary, as well as the risk/benefit ratio of going to the OR again to improve upon a patient's suboptimal outcome with their Gastric Banding.

One last comment.  As I have stated a few times earlier in this Blog, the majority of our Band patients are still doing well with their weight loss and are enjoying their "tool" as they gain control over their eating habits and resultantly their weight.  Some of those patients, for the first time in their lives.  But if that is what is needed / desired, it can usually be accomplished by switching out to a different procedure such as a Bypass or a Sleeve as either a one-time procedure, or occasionally in a 2 stage process.