Bariatric revision surgery, have you had or considering?

Hi, @roch - Thanks for starting this discussion on bariatric revision surgery for those who have gone through it or are considering it.

I'm tagging a few members who have talked about weight loss-related revision surgery or contemplating revision surgery, or even that they are not considering revision surgery: @mcordeiro @projfan @aunt. @grandmar @dlc1953 @shrinkerbell @wr61 @mom2five @nova1976 @nrosa0311 @missstephyl @sandytoes14 also may have some thoughts. Hoping you will share your experiences with revision surgery due to weight regain or complications from your weight loss surgery, your thoughts as you consider revision surgery or just your insights on revision surgery.

I thought about revision surgery, but I didn't have it done.
I lost. 90 lbs. from the surgery. I gained back about 10. I have gone up and down those pounds. I never went over. My husband kept a watchful eye on me.
I lost my husband 3 years ago. I could only get down comfort foods. I gained 30 lbs. over the 10.
I did not know what to do about the gain. I briefly thought about revision but decided against it. I opted for shots instead of the surgery. I've gotten back down to my post surgery weight plus an additional 8 lbs. Now, I am nearly 100 lbs down including surgery. It is my intention to go down another 7 to 10 lbs.

I, too, pursued the new GLP-1 RAs after I put back on almost half of the weight I had lost due to the surgery, which took about a decade.

I suppose I think of revision surgery as something to do if an original surgery fails, for various definitions of fail. In my case, I did not consider the original surgery a failure -- the weight regain traced to other problems. (Although, to be fair, part of it was a mishandling of post-surgical dumping, which left me with some bad habits.)

I have more recently contemplated a knee replacement, and approached it in a more knowledgeable way, digging more deeply into side effects and success statistics. In fact, I specifically went for a second opinion with a surgeon who specializes in revision surgery.

So that would be my first suggestion: look for a surgeon who has done a lot of revision surgery, which might mean a long wait for an initial consultation, since these people are not thick on the ground. My second would be to clearly understand what is driving you to contemplate revision surgery -- what "success" looks like to you. What, exactly, do you regret about the first surgical outcome that you are trying to fix? My third would be to poke hard into the extent to which the outcomes might be worse instead of better a second (or third) time around. And last but not necessarily least, make sure you explore the question of insurance coverage for revision surgery -- I have no idea what the circumstances are under which an insurance company would pay for this.

All good thoughts projfan.

My original surgery was a sleeve gastrectomy in 2012. I lost all the weight my body wanted 130 pounds. I never set a goal weight. I trusted my body to let go of the weight. I ate very low carb. I started to suffer from severe GERD. I was on a PPI with no relief. In 2018 I revised to Bypass due to the severity of the GERD and my surgeon's concern that I would develop Barrett's Esophagus. At first, I had relief. I was concerned I would lose too much weight. I had gained about 20 pounds. My main concern was the GERD. After about a year, symptoms came back again. I had a hiatal hernia repair. I still had no relief. Different surgeon, felt it might be bile acid. I have changed to a new gastroenterologist. After many tests, it was discovered that I had 2 marginal ulcers where the bypass was done. My pancreatic enzymes are low. My gallbladder was full of debris and sludge. Removal of gallbladder with no relief. I was referred to an esophagus specialist by my gastro. I had to stop the PPI for 10 days for a test to measure the acid. By day 5 the ulcers had hemorrhaged and I was in the ER at which time they restarted the PPI. My gastro said it is very rare and now won't let me get off the PPI. I am currently on a bile salt to see if that helps. If anyone cares about my weight, bc honestly I don't, I lost all weight and am having trouble keeping it on,

Welcome to Mayo Clinic Connect, @kimmy1970. That is terrific you lost 130 pounds after your sleeve gastrectomy. Sorry to hear that after that the gastroesophageal reflux disease (GERD) got so bad and that the revision to bypass and hiatal hernia repair did not provide lasting relief, nor did gallbladder removal.

Sorry to hear you also had hemorrhaging in your ulcers where the bypass was done.

Did your gastroenterologist or your esophageal specialist prescribe the bile salt? You mentioned taking this to see if it helps. Wondering if that would be with symptoms or GERD, or something else?

I am taking the bile salt so far no positive results. He believes I also have GERD, but the PPI is no longer effective. He is willing to try and take me off the PPI. I have to be ready for a possibly another bleed. I asked if they would reverse the bypass. The 3 surgeons I met with said it could be risky as the blood flow to the area of reattachment is poor. The symptoms are burning in the center of my chest and the back of the throat. The odd thing is it is not everyday, but more days than not.

A new paper just out that might be relevant here (Revisional endoscopic sleeve gastroplasty versus semaglutide and tirzepatide for weight recidivism after sleeve gastrectomy ): https://pubmed.ncbi.nlm.nih.gov/39909715/.