As weight loss procedures become more and more popular, it’s important to be aware of the different types of bariatric surgery. Although a lot of people experience success with these big decisions, some patients struggle with the outcomes, whether that is insufficient results, complications or side effects that don’t seem to go away. While some procedures allow reversal, others make it very difficult due to several factors.
Why reverse bariatric surgery?
Whether it’s the patient or the doctor, there are several reasons to seek reverse bariatric surgery:
- Insufficient weight loss: Some healthcare providers consider that if within the first two years the patient loses less than 15% of their total body weight, they might be considered a candidate for reversal surgery. That number, however, depends on a lot of factors, such as the type of surgery, the surgeon’s skills, the patient’s health condition, etc.
- Complications: In some cases, the procedure can cause surgical complications such as band slippage from gastric band procedures, saline leaking from the gastric balloon, gastric fistula from gastric bypass surgery, and hiatal hernia, amongst others. If this happens, the patient might have to undergo surgery to fix the problem or even completely reverse the initial procedure.
- Chronic side effects: Some patients might experience bariatric surgery side effects that don’t seem to disappear despite medical interventions. Some of the most common side effects are acid reflux from gastric sleeve, difficulty swallowing, chronic nausea, obstruction of the stomach, or infection.
- Malnutrition: When surgery related to the stomach and digestive system prevents food nutrients from being absorbed into the body, it leads to malnutrition. While following a diet plan and taking food supplements can usually fix this issue, some patients might experience severe nutrient deficiency and liver failure, requiring surgical intervention.
Ultimately, a team of professionals would decide whether reverse bariatric surgery is necessary in each case, evaluating the risks and benefits of the procedure.
Reversible vs. Irreversible Bariatric Procedures
But not all bariatric surgeries can be completely reversed. Most surgeons opt for modifying or transforming a bariatric procedure into another rather than full reversals.
Reversible Bariatric Procedures
Gastric Bypass
The gastric bypass procedure creates a small pouch at the top of the stomach and connects it to the small intestine.
One of the reasons why the patient might want to reverse their gastric bypass surgery is that the small pouch might get stretched out over time, causing more food to enter and reducing its effectiveness.
A complete reversal of this surgery is difficult, as part of the stomach has been divided from the other. The surgeon would have to re-establish the original connections, which can be made, but it’s considered a very dangerous procedure. Surgeons often prefer converting the bypass into a gastric sleeve, so it continues to be effective.
Gastric Band
Gastric band surgery reduces the amount of food you can eat by placing a silicone band around the stomach. Often, the band slips and stops working effectively, or the friction between the band and the stomach causes inflammation. In these cases, the band can be removed and reinserted some days after. The option to easily remove the band makes this one of the few truly reversible bariatric procedures.
However, it’s becoming less popular because of the complications it can cause and the lack of effectiveness in the long term.
Irreversible Bariatric Procedures
Generally, irreversible bariatric surgery involves removing part of an organ, making reversal difficult, as the removed portion cannot be restored.
Gastric Sleeve
Gastric sleeve surgery consists of removing a big part of the patient’s stomach, leaving a smaller, tube-shaped stomach. Although this can’t be reversed, in some cases it has been converted into a gastric bypass or duodenal switch to continue the weight loss process.
Duodenal Switch
The duodenal switch combines elements of gastric sleeve surgery and intestinal bypass by reducing the stomach’s size and bypassing a big portion of the small intestine. This procedure is considered irreversible, but some skilled surgeons might be able to reverse part of the connection between the intestine and the stomach. Still, such a reversal is very complex, and it has been performed only a few times.
Factors that affect the reversibility of bariatric surgery
As we’ve seen, some of these procedures can be reversed or transformed into another weight loss procedure. However, even if a reversal is possible, three factors would influence whether the surgery is performed or not.
- The patient’s overall health: If the patient has other health conditions or they are in a vulnerable physical situation, it could make them unsuitable for the reversal procedure, as these surgeries tend to be very delicate.
- Time since surgery: The longer time it passes since the initial surgery, the more challenging a reversal becomes. Over time, scar tissue develops in the incisions and new connections between the organs, which makes it trickier to cut again.
- The skill of the surgeon: Reversal bariatric surgeries are not the same as the initial surgeries. These procedures require highly skilled and experienced surgeons. If the surgeon doesn’t have extensive experience performing that surgery, they might decline the case entirely.
Risks of Reversing Bariatric Surgery
Once the surgeon determines that the patient is a suitable candidate for reversal bariatric surgery, they should both discuss the potential risks that come with these kinds of procedures:
- The less dangerous but most probable is the loss of weight loss benefits. It’s common that, after performing the reversal surgery, the weight loss and health improvements caused by the initial intervention eventually disappear, and the patient finds themselves at square one. That’s why it’s important to have a plan post-operation to maintain these improvements.
- Generally, reversal surgeries are more complex and riskier than the original procedure. Factors like scar tissue development, altered anatomy, and an overall difficulty of the operation increase the likelihood of complications, whether those are infections, bleeding, or other injuries.
- Another outcome of the reversal surgery is that the initial problem is not resolved. The patient might still experience pain or discomfort even after the reversal surgery is done, or they might still not lose weight after an adaptation of the surgery is performed.
Deciding to reverse bariatric surgery is a complex decision that should be discussed by multiple healthcare professionals and, if pursued, should be performed by a skilled reversal surgeon.
For those exploring temporary alternatives with higher success rates, the Spatz3 gastric balloon offers a less invasive option. This adjustable balloon is placed inside the stomach and removed after several months, without the need of cutting or manipulating any organs, making it easier for the body to adapt.
Take a look at the comparisons of gastric balloon vs gastric band or the sleeve vs the balloon to educate yourself on the pros and cons of all weight loss procedures. Ultimately, the key to making an informed choice lies in open communication with the medical team, access to psychological support, and a thorough understanding of the long-term outcomes.
