Weight Regain After Gastric Bypass Surgery

Weight Regain After Gastric Bypass

Have you had a gastric bypass in the past?  Even an open bypass?  If you are struggling with weight regain, or lack of restriction, there may be a problem that can be corrected. Dr Balalis has significant experience in dealing with revision operations and has the appropriate tools to assist. This includes conversion to a different operation, changing your pouch, placing a Minimizer ring or performing an endoscopic procedure to decrease the outlet using the Overstitch system.

Several issues may be contributing to weight regain after a gastric bypass.  Dr Balalis discusses these below:

• There may be a fistula between the stomach pouch, and the remnant stomach
• • This can be revised
• The pouch may be dilated
  • All parts of the body dilate, and the gastric pouch is no different
  • This can be revised
• The outlet, or stoma, is dilated
  • This can be revised with an endoscopy procedure that Dr Balalis performs using the Overstitch

There are procedures available to assist with weight regain (if significant) with the purpose to re-establish restriction.

Minimizer Ring

Placing a Minimizer Ring around the pouch to re-create restriction in certain circumstances.  Studies have shown that the Minimizer Ring reduces and prevents long-term weight regain. The Minimizer Ring can placed on a primary bypass as a ‘safeguard’ for weight regain. But it can also be placed at a later date on it’s own or during revision weight loss surgery to assist with the prevention of weight regain.

Revision Surgery

Refashioning of the gastric pouch.  This may also include complete revising of the stomach to small bowel join (gastrojejunal anastomosis), possibly with replacing the entire small bowel limb (Roux limb).  This is essentially redoing the entire operation, and can be performed for particular cases/issues.

Revision Endoscopic Surgery with Overstitch

The Overstitch system allows Dr Balalis to reduce the size of your join between the stomach and small bowel (gastrojejunal anastomosis) via an endoscopy.  This can be performed as day surgery, and provides restriction again for patients following Roux-en-Y and one anastomosis gastric bypass.  This is an option, even many years following a bypass operation.

The Overstitch  reduces the pouch outlet diameter using a flexible fibre optic endoscope placed through the mouth into the stomach.  More information on this procedure can be found here:  http://apolloendo.com/procedures/outlet-pouch-reduction/.

Note: An option that is not performed by Dr Balalis is placing an adjustable gastric band (such as “Lap Band”) over the pouch to help maintain restriction – this operation is an option but not one that Dr Balalis offers. The data shows that lap bands are not effective for weight loss and also cause symptoms for patients

There are always risks with surgery, and the risks versus benefits need to be discussed with Dr Balalis. It is also important to know what options you if you are if experiencing weight regain. If you would like to discuss your options further with Dr Balalis please contact our rooms.

Awad et al –Ten Years Experience of Banded Gastric Bypass: Does It Make a Difference?
Schaeur – Banded Roux-en-Y gastric bypass for treatment of morbid obesity
Buchwald et al – Systematic Review and Meta-analysis of Medium-Term Outcomes After
Banded Roux-en-Y Gastric Bypass
Prof Lange (Bariatric News) – Do it right the first time: Banded bypass reduces long-term
regain
Lemmens (Bariatric News) – Maximise weight loss with MiniMizer Ring