Revisional bariatric surgery is the generic term that refers to follow-up surgical procedures performed in patients who previously had any type of bariatric (weight-loss) surgery. There are three categories of revisional bariatric surgery: Correction or modification, alteration, and reversal. The follow-up procedure may improve the effectiveness of the original surgery and a patient’s quality of life (if the initial surgery caused unwanted side effects).

Revisional bariatric surgery procedures occur in about 7% to 15% of bariatric surgery patients. To determine whether a revisional bariatric surgery is needed, doctors will assess a patient’s overall health, weight loss progress, and any quality-of-life issues (more on that below that have arisen since the initial surgery.

Revisional bariatric surgery is a broad term used to describe follow-up procedures required for patients who previously had weight-loss surgery. An additional procedure is intended to make a patient’s initial weight-loss procedure more effective, to minimize unpleasant side effects, or to reverse the original surgery.

A patient may be a candidate for revisional bariatric surgery for one or more of the following reasons:

• Insufficient weight loss. Sometimes, a patient doesn’t lose the expected amount of excess body weight during a set period of time after surgery, such as 18 months or two years. Although there are no official weight-loss guidelines establishing the treatment effect of an initial bariatric procedure, many studies suggest that patients may be candidates for revisional bariatric surgery if they lose less than 15% of their total body weight.
• Complications. Sometimes, complications can arise from an initial bariatric procedure. For example, a patient who has had gastric band surgery may experience band slippage around the stomach, or the band may erode into the stomach’s inner lining. In some cases, saline may leak out of the tubing within the gastric band.
  
  A small number of patients who have gastric bypass surgery also develop a gastric fistula (when the small stomach pouch develops an unwanted connection to a portion of the bypassed stomach).
  
  A patient who undergoes any type of weight-loss surgery may develop a hiatal hernia, which occurs when a small section of the stomach is pushed upward (from the abdomen into the chest cavity), causing heartburn and/or discomfort. Patients may also develop ulcers (sores) or strictures (narrowing of the stomach pouch or the connection between the stomach pouch and small intestine).

• Side effects. Some patients who undergo bariatric surgery develop side effects after the initial procedure. For example, some sleeve gastrectomy patients develop acid reflux, or gastroesophageal reflux disease (GERD). Another symptom that may arise is difficulty swallowing.
• Weight regain. Some patients regain weight. For example, a patient who had an initial sleeve gastrectomy may begin to gain weight and develop GERD symptoms. After gastric bypass surgery, the spot where the section of small intestine has been connected to the bottom of the stomach pouch (the gastrojejunal anastomosis) may become dilated, reducing the output of satiety or “fullness” hormones, also leading to weight gain.
• Malnutrition. Occasionally, an initial bariatric procedure prevents too many nutrients from being absorbed from food, leading to malnutrition, vitamin deficiency, or too little calcium in the blood (hypocalcemia). Sometimes, the initial bariatric procedure can be slightly modified during revisional surgery. In rare cases, the entire procedure is reversed, especially if the patient experiences liver failure along with malnutrition.

There are a number of ways surgeons can revise an initial bariatric surgery. What happens during revisional bariatric surgery depends on the problems that arose after the initial surgery and whether surgeons plan to repair, convert, or reverse that procedure.

These revisional surgical options are often employed for the three most common types of bariatric surgery:

• Sleeve gastrectomy. In this procedure, doctors surgically remove a significant portion of a person’s stomach, which reduces the volume that the stomach can hold by 80%. As a result, the stomach looks more like a tube that food travels through rather than a pouch that can hold and help digest food. Sleeve gastrectomy is not reversible.
  
  After a patient initially has sleeve gastrectomy, the stomach may become stretched out or enlarged, leading to weight regain. Instead of recreating a smaller stomach sleeve, surgeons typically convert sleeve gastrectomy to gastric bypass or a duodenal switch procedure. Converting to gastric bypass is also an effective treatment to manage GERD symptoms that may have arisen as a result of sleeve gastrectomy.
  

• Gastric bypass surgery. During the procedure, also known as ”Roux-en-Y” gastric bypass, surgeons section off a small pouch of the patient’s upper stomach (near the esophagus) to hold food. Surgeons then reroute part of the small intestine, connecting it to the bottom of the newly created stomach pouch. When a patient eats, the food enters the small stomach pouch, then moves into the small intestine, bypassing the majority of the stomach and a portion of the small intestine.
  
  Over time, the small stomach pouch may become stretched out or enlarged. This can be corrected surgically or endoscopically or anti-obesity medications can be employed.
  
  The gastric bypass may also be converted to a SADI, single anastomosis duodenal-ileal bypass with sleeve gastrectomy. The gastric bypass is reversed by reattaching the stomach, performing a gastric sleeve, reattaching the previous small bowel, and attaching a loop of the small bowel to the end of the gastric sleeve.
  

• Gastric band surgery. Sometimes called Lap-band surgery, doctors place an adjustable silicone belt (or band) around the upper portion of the patient’s stomach, dividing it into two sections. Patients feel full sooner than they would without a band restricting their stomach size.
  
  If a patient initially had gastric band surgery and the band has slipped out of place, surgeons may simply place the band back in the correct location. In some cases, surgeons remove the band for several weeks before replacing it—a gastric band in the wrong location may have caused inflammation or scarring that needs time to heal before resetting. It’s also possible for surgeons to convert gastric band surgery to sleeve gastrectomy, gastric bypass surgery, or the SADI procedure.

Revisional bariatric surgery is used to modify, correct, or reverse a prior bariatric surgical procedure. Initial bariatric procedures are offered to some patients with obesity as an effective way to help them lose—and keep off—excess body weight. A variety of circumstances may arise after an initial bariatric procedure, leading to a follow-up surgery that can address these issues.

Revisional bariatric surgery is performed to improve a patient’s health or quality of life. The procedure may encourage greater weight loss in patients whose initial surgeries did not lead to the expected loss of excess body weight. It may reduce or eliminate unwanted side effects that arise after an initial bariatric procedure, such as GERD or swallowing difficulties. It may also address complications from the initial bariatric surgery, such as an ulcer or stricture. Or, it may completely reverse the initial bariatric procedure when it is no longer wanted or effective.

Some revisional bariatric procedures are performed as open surgery, which is associated with a greater risk of bleeding, more pain at the incision site, and a longer recovery time compared to minimally invasive laparoscopic surgery.

Revisional bariatric surgery can carry more risks than initial bariatric surgery. It has higher rates of complications and death. Patients are also less likely to lose the expected percentage of excess body weight. Sometimes, revisional surgery does not resolve the problems that arose after the initial surgery. However, for many patients, revisional bariatric surgery helps to promote weight loss and improve quality of life.

This article was medically reviewed by Neil Floch, MD, a Yale Medicine bariatric surgeon and director of Bariatric Surgery at Greenwich Hospital, and John Morton, MD, MPH, MHA, medical director of Bariatric Surgery for the Yale New Haven Health System.