Nuts and Bolts of Band Revisional Surgery, Part 3

From fun107.com

We just got back from returning one of our kids to college.  Talk about a time ripe for the unexpected!  As one of my sons says,  sometimes in a taunting fashion, "You don't know what you don't know".

How true, especially when it comes to this time of (hopeful) maturation into adulthood, a journey that college automatically provides on so many levels.

I think the corollary to the saying of what you don't know is equally as helpful, and can take some of the angst out of what is coming up.  If you know you don't know (everything), then that's a safer place to start from.  Because not to know that you really don't know, is really the truest definition of not to know... Ya know?

If you can follow that, the rest of this entry will be a piece of cake (no bariatric pun intended).

Part 3

To quickly summarize, we have discussed the issues leading to the necessity of Band revisional surgery,  and have covered what it takes to undergo an additional surgery to improve upon some form of an undesirable situation with a Band patient. And now,  the final portion.

Which surgery type is the best for a patient to have once they have "failed" their Banding procedure, either through lack of weight loss (or substantial weight regain), or they have experienced an untoward effect of the Band, or both, as described earlier?

There are subtleties involved here, as the only 2 other procedures we perform in our practice are Bypasses and Sleeve Gastrectomies.  Both will work here, and we have successfully done both as revisional procedures.  Yet, as much as we may want to separate the two, from a revisional sense, they are essentially more similar than different, and both excellent options for a number of reasons.

Both are metabolic, that is they have beneficial metabolic effects, as contrasted to the Band which essentially does not.  Both have a better track record of generally inducing a larger degree of weight loss than the Band, and certainly at a faster rate than the Band.  Most studies also show that each procedure keeps off weight longer and to a greater extent than the Band does.

Either procedure can be performed as a one stage procedure, (that is Band out to Bypass, or Band out to Sleeve) but occasionally it is safer to do it in 2 stages. That situation may arise if the stomach is significantly inflamed or irritated from a pre-existent mechanical issue with the Band, or if surgical landmarks are just not clear enough to risk the conversion in one stage.  In that case, we would take out the Band and access port at the first operation, then come back for the new procedure.  Certainly it is better to wait than risk a complication that may either delay or even negate the chance at performing a revisional surgery.

So, in summary, all is not necessarily lost if a patient does not do well after Band surgery,  or if they develop a significant untoward effect from the Band.  Revisional surgery, for those who qualify, is a possible option to be reviewed with the patient by our Bariatric staff,  keeping in mind that old standard yet simple equation: risk vs. benefit.

We are here to help in any way we can, especially if we can reduce what a patient doesn't know about what they may not know :)