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All surgical procedures for obesity, both old and new, are designed to change how the person processes food. Although many of these procedures are designed to be permanent, in reality not all the effects of the surgery are permanent. All patients perceive their operation to change as months and years pass.
These surgeries change how the oesophagus, stomach and small bowel work. Over time these change their function, stretching, softening and adapting to the surgery. Some of these changes can lead to patients developing risks for complications such as ulcers, reflux and nutritional problems, others lead to the operation not seeming quite as “powerful” at controlling how you eat.
Bad Habits Return – weight regain
All bariatric surgery procedures suppress appetite and make you eat slowly. If the person learns to eat small, regular meals (three meals a day) and avoid snacking and liquid calories, they will generally do well in the long term.
For most patients with weight problems, the tendency to snack, graze and comfort eat was a major contributor to their original weight problem. If these behaviours persist after surgery we expect their weight problem to come back. Some weight regain occurs in the large majority of patients after surgery, usually due to snacking rather than eating large meals.
Unfortunately it is very common for patients to drift away from their initial enthusiasm and gradually stop looking after themselves and their operation. This weight regain can lead to problems with how the operation works, and complications that require surgical intervention.
Not Your Fault
It’s normal for all of us to spend periods of time when we fail to “self-care” appropriately. All of your care team are human and make similar mistakes, which is why we are happy to try to help when things don’t work as well as you would have liked.
Being compliant and sensible following bariatric surgery does not guarantee a hassle-free operation, although it will reduce the risk of problems by about 75%. Many of the older types of operation (stomach stapling, older banding operations) had design faults that led to problems in their function over time, even if patients did the right thing.
In general, between about 10% – 30% of patients having any type of bariatric surgery will end up needing later treatments to treat complications or weight regain. One of the main reasons patients should return to their bariatric team for follow-up is to reduce the risk of repeat surgery and to notice and treat any problems early.
Bariatric Revision Surgery
“Revision surgery is quite common. To date I have performed about 1,000 re-operations on weight loss patients – I usually do two or three of these operations per week.” – A/Prof Michael Talbot
Thankfully, many patients seek help when they start to regain weight and can get back on track relatively easily, but there are others who only seek help after they have regained large amounts of weight.
This group who only seek help when they have regained significant amounts of weight, probably accounts for about 75% of the patients who need redo surgery after a previous bariatric surgery procedure. They can be easily identified because they have previously stopped coming in for follow-up appointments, they have stopped taking their vitamins and have ceased regular eating and exercise habits.
In the other 25% of patients requiring redo surgery, weight regain is due to the development of a technical problem with their operation. If they present before they have had massive weight regain, solving the problem is fairly straightforward.
A/Prof Michael Talbot has performed more revision weight loss surgery procedures than any other bariatric surgeon in NSW, and for longer. If you would like to discuss your options for revision surgery, please contact our practice.
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