Studies show that 15-35% of patients who undergo Roux-en-Y gastric bypass (RYGB) struggle with weight regain after surgery. Surgeons have offered revision for weight loss surgery to these patients as a way to encourage additional weight loss. However, no surgery is without risks nor complications.

Is is okay to have weight loss surgery twice?

In one study – completed in the Netherlands – physicians looked back on 47 patients who had unsuccessful long-term weight loss from their original RYGB. These patients underwent a second surgery to revise their original surgery.

In this revisional weight loss surgery, their alimentary limb was surgically lengthened.

Alimentary Limb

The alimentary limb is a connecting piece of small intestine that empties the small stomach pouch to the very end of the small intestine.

Take a look at the image below. The purple arrows represent food traveling down the alimentary limb. As food travels down the esophagus, it empties into the small stomach pouch. From there, it continues through a connecting piece of small bowel before emptying into a “common channel” of small bowel. The food then enters the large intestine.

 

Outcomes from lengthening of the alimentary limb

During a revision of RYGB weight loss surgery, the alimentary limb is reconnected at a lower point down the “track.”

How much weight do you lose after gastric bypass revision?

About 62% of the patients in this study who successfully completed the weight loss surgery revision had adequate weight loss. Their total weight loss improved from 12% to 30%.

What is the success rate of gastric bypass revision?

Of the 47 patients in the study, 67% of those who had diabetes experienced remission. Roughly 50% of those with high blood pressure had remission as well.

But not everyone had positive outcomes:

• 1 patient passed away within 30 days of surgery likely due to an internal hernia
• 11% of patients experienced protein malnutrition or horrible diarrhea (some were having diarrhea 7-20 x / day!).
• Some experienced complete loss of control of their (liquid) bowel movements
• Even though these patients were placed on maximal dosing of Bariatric multivitamins, 89% developed nutritional deficiencies.
• The most common nutritional deficiencies were calcium, vitamin A, vitamin D, selenium, zinc, and protein (albumin < 3.2 g/L)
• Some of these patients required intensive follow up, injections, admission to the hospital for tube feeding, and an additional surgery to correct the length of the alimentary limb again

Bottom Line

This was a small study that looked at patients who had already undergone a weight loss surgery revision (retrospective study).

If you’ve had Roux-en-Y gastric bypass and have been struggling to continue to lose weight after surgery, there are more surgical options available to you, as this study suggests.

This specific type of revisional weight loss surgery has potential weight loss benefits including possible remission of diabetes and high blood pressure.

Unfortunately, it does not come without the risk of nutritional deficiencies, significant diarrhea, and a decrease in quality of life.