Weight-loss and Well-being WITH THE INCREASING POPULARITY OF BARIATRIC SURGERY WORLDWIDE, THERE HAS BEEN A SUBSEQUENT INCREASE IN THE NUMBER OF PEOPLE DEVELOPING PROBLEMS FOLLOWING SURGERY, OR PEOPLE NOT LOSING AS MUCH WEIGHT AS INITIALLY HOPED FOR. AS A RESULT, BARIATRIC SURGEONS ARE PERFORMING INCREASING PROPORTIONS OF REVISIONAL PROCEDURES. DESPITE THE MASSIVE POSITIVE IMPACTS BARIATRIC SURGERY HAS ON BOTH THE PHYSICAL AND MENTAL HEALTH OF PEOPLE, THERE ARE CERTAIN DRAWBACKS WITH EVERY TYPE OF WEIGHT-LOSS PROCEDURE. SOME OF THESE ISSUES ARE MILD AND MANAGEABLE, HOWEVER THE QUALITY OF LIFE OF MANY PEOPLE IS AFFECTED TO THE DEGREE WHERE THEY REQUIRE RE-OPERATIONS TO IMPROVE THEIR WELL-BEING: REVISIONAL BARIATRIC SURGERY
Gastric Bands Australia more than other parts of the world has seen gastric bands become the predominant bariatric procedure performed over the previous decade. Over 100,000 people in Australia have received a gastric band since 1994. Many people with gastric bands have either had a great deal of success followed by complicated band issues, or have never really succeeded to losing as much weight as they initially hoped for. Sometimes the distortion of the gastro-oesophageal anatomy can produce symptoms that manifest themselves many years later. The common problems seen are band slippage, pouch or oesophageal dilatation, and excessive scar formation beneath the band. These problems lead to symptoms of severe reflux and vomiting/regurgitation after meals. The options available to patients in this
setting include removal of the band, attempt at repositioning the band to a more functional position, or removing the band and converting to another weight-loss procedure. Band removal and conversion to another bariatric procedure is becoming increasingly common. The most common option is conversion to a gastric bypass. Band removal and conversion to a gastric bypass can be performed safely in the same procedure in many cases, saving the patient an additional general anaesthetic and operation. Sometimes the scarring or distorted anatomy as a result of the band necessitates removal of the band and a delay of about 3 months before a later conversion to a bypass. Conversion from a band to a sleeve gastrectomy is also possible however surgeons who do this generally delay the sleeve gastrectomy 38 slim magazine Summer 2021/22
several months due to the higher risk of a combined procedure. The risk of a sleeve gastrectomy leak of the staple line is dramatically increased in this setting, and can be an extremely difficult problem to deal with, potentially leading to a prolonged hospital stay. Gastric bypass is generally accepted to be the most effective option to induce further weight-loss after a failed gastric band. Evidence demonstrates better long term weight-loss, improved food tolerance, and a better quality of life with gastric bypass relative to sleeve gastrectomy following removal of a band. The consensus among international consensus meetings is that a conversion of a band to a bypass is the preferred operation.
