Revisional bariatric surgery

There is some risk with all primary bariatric surgery but revisional surgery, no matter what the original operation, has an inherently higher risk than primary surgery.  (eg. a sleeve or gastric bypass after a band is higher risk than a primary sleeve or bypass. ie. no previous surgery).  Even revising a gastric band is a higher risk than inserting one.

The risk relates to the development of adhesions after the first operation.  Some patients develop more adhesions than others.  Adhesions cause the organs and abdominal wall to stick together making normal tissue planes more difficult to identify.  This results in a higher possibility of organ perforation leading to leakage of gastro-intestinal contents into the peritoneal cavity.  Diagnosed early and presenting early this can be treated but may result in a prolonged hospital stay. 

On occasions, it does not present until after the patient has left hospital.  It is therefore important to contact your doctor or hospital if you have increasing pain, shortness of breath, vomiting, or feeling unwell once you leave hospital.  Delay in the diagnosis can, rarely lead to death and it is imperative to consult your doctor if you have symptoms of which you are concerned.

Talk to your surgeon

The aim of this document is to provide you with general information. It is not a substitute for advice from your surgeon A/Prof Nottle, and does not contain all the known facts about revisional bariatric surgery or every possible risk.  Use this only in conjunction with his discussions with you.  

Some medical terms in this document may need further explanation, A/Prof Nottle will be pleased to answer questions and it may be helpful to make a list of those you wish to ask.  If you have any concerns about treatment, please discuss them prior to surgery.

It cannot be guaranteed that treatment will meet all of your expectations and has no risks.  You may wish to seek a second opinion from another surgeon.

Consent form:  If you decide to undergo surgery, A/Prof Nottle will ask you to sign a consent form.  Read it carefully and if you have any questions, ask them.

Anesthesia

Revisional bariatric surgery is performed under general anesthesia.  Modern anesthesia is safe and effective, but can pose risks for the obese patient.  Rarely, side effects from an anesthetic can be life threatening.  Ask A/Prof Nottle and your anesthetist for more information.

Give your anesthetist a list of all medicines you are taking or have taken.

Recovery after surgery

The length of hospital stay depends on the type of surgery and whether complications occur.  The hospital will give you detailed dietary information before you are discharged.  Most patients are on a liquid diet for the first week because solid foods could strain incisions.  You may have pain in one or both shoulders that may extend into the neck.  Carbon dioxide gas used during laparoscopy is thought to be the cause.  Over the counter pain medication is usually enough to relieve the pain.  A/Prof Nottle can prescribe stronger pain relief medication if needed.