MANAGEMENT OF FAILED BARIATRIC SURGERY

Abstract

Bariatric surgery is effective in achieving durable weight loss, but weight regain postoperatively is a common and significant problem. It reintroduces the risks of obesity-associated diseases and has significant impact on quality of life. Although initial weight loss after bariatric surgery is often dramatic, a weight plateau is typically achieved in 1–2 years. Approximately 20% of patients do not lose 50% of excess weight within 1 year of surgery; 30% of patients experience weight regain by 2 years postoperatively, and 63.6% regain within 4 years. Because of the large number of patients undergoing bariatric surgery, demand for therapy to address weight regain will continue to increase. It must first be established whether it is the patient who has failed the bariatric surgery, or the bariatric surgery that has failed the patient. Patients may not be properly educated on how to make their bariatric surgery work best for them. While ensuring proper education prior to bariatric surgery will help a patient achieve and maintain weight loss, adequate long term care and support may be all a patient needs to get "back on track." After a period weight regain however, it may be extremely difficult for a patient to lose the weight they have gained back. Quite frequently, the bariatric surgery metabolically and/or mechanically fails the patient. Mechanical failures that arise after the anatomical changes made during the original bariatric surgery, are not maintained. Like pouch stretch, fistulae, changes in the intestinal absorptive surface and band slippage or erosion.