Can You Have Gastric Bypass Twice?

So can you have gastric bypass twice? The short answer is no…

but there are other options…

Gastric bypass is still considered the Gold Standard in bariatrics; however, its success is not guaranteed and it may be necessary to eventually revise your gastric bypass into a different bariatric surgery to help restart weight loss.

Over time it’s possible for weight loss to stall and even be gained back, in fact weight gain after gastric bypass surgery has been seen in as many as 73% of patients.

If so many patients are experiencing weight gain after gastric bypass, what’s the solution?

Why you cannot have Gastric Bypass Twice

After a gastric bypass the bulk of your stomach and small bowel are bypassed. You can’t bypass more stomach and bowel, it’s already been done and can’t be done any further.

Put simply, you can’t cut off the same arm twice.

However, just because the first surgery, the gastric bypass, didn’t produce the weight loss you want and need, you still have other options.

Revision Surgery vs. Conversion Surgery

Revision surgery is when there is a mechanical issue with the original surgery that needs fixing.

For Gastric Bypass patients it’s common for ulcers to form that can’t be managed with medication. That needs surgical intervention to be fixed using revision surgery.

Conversion surgery, on the other hand, is directly related with “failed weight loss.” (Failed weight loss sounds harsh, but that just means the surgery didn’t produce the desired amount of weight loss.)

In this case, you need to have your original surgery CONVERTED to a different weight loss surgery.

Why do some gastric bypass patients regain weight?

Life happens

Whenever we make plans for ourselves and set goals, life has a way of planting itself right in the middle of our path. Whether it be illness, family obligations, or difficult work conditions, staying on track with your bariatric diet can fall by the wayside.

The honeymoon phase ends

The honeymoon phase is the period of time shortly after you have your bariatric surgery. During the first 6-12 months post-op the weight tends to naturally fall off without much effort.

Why? Well, for the first 4 months you’re following some form of a 4-Phase Post-Op Diet which systematically limits your calories, carbs and fats. Secondly, you’re the most motivated you’ve ever been to lose the weight for good. The proper diet plus sky-high motivation is a recipe for the results you want: weight loss.

But after the first 6-12 months losing weight becomes difficult and it takes direct effort.

It’s like holding down a life-vest underwater. If you can keep your attention on it and hold it down you can keep it underwater. But the second you let up the life vest pops right back up.

And weight loss is the exact same way

Old habits come back

Habits don’t form overnight and they won’t’ go away overnight either. The longer you’ve had habits the harder they are to break over the long term.

Whatever cravings you had before surgery may dissipate during the honeymoon phase, but once you’re 12+ months out from surgery those same cravings will come back.

For some patients, revision surgery can be a viable option to get back on track to help them lose the necessary weight.

What is gastric bypass revision/conversion surgery?

Revision surgery is when another surgery is performed to correct the issue that could be causing the weight gain/plateau. These surgeries are normally performed laparoscopically and are meant to convert your current surgery to a different bariatric procedure.

Revision surgery is performed for 2 reasons:

• Weight gain
• Complications related to the original surgery

Possible conversion (revision) surgeries are:

• Gastric Banding → Gastric Bypass
• Gastric Banding → Sleeve Gastrectomy
• Sleeve → Gastric Bypass
• Sleeve Gastrectomy → Duodenal Switch
• Gastric Bypass → Duodenal Switch

Weight loss surgery limitations

Not all bariatric surgeries are equal. The gastric band will not produce the weight loss that the sleeve gastrectomy will produce. The sleeve won’t produce the amount of weight loss that the Gastric Bypass will produce. The Gastric Bypass won’t produce the weight loss the Duodenal Switch will produce…etc. and so on.

It’s safe to say that some procedures can statistically only produce so much weight loss, and that’s okay if that’s what’s happening.

Who should consider gastric bypass revision or conversion surgery?

As stated earlier, you should consider revision surgery if:

• You are experiencing weight gain after your original bariatric surgery
• You are experiencing complications after your bariatric surgery.

Weight Gain (conversion)

• Gastric Bypass – your pouch could have stretched to some degree allowing you to eat more food at one time; your stoma could have stretched which makes you feel hungry sooner after a meal; life can get in the way and distract you from your weight loss goals
• Sleeve Gastrectomy – your sleeved stomach could have stretched to some degree; old eating habits have a way of creeping back into your life; stress and other emotional factors can push you off course

Complications after your bariatric surgery (revision)

• Gastric bypass – you can develop a chronic ulcer that can’t be cured by medication or other lifestyle changes; malnutrition; bowel obstruction
• Sleeve Gastrectomy – Acid reflux is common after the gastric sleeve; pouch stretching; weight regain is actually a complication of bariatric surgeries

Complications with gastric bypass revision surgery

Revision surgery is, after all, surgery. All surgeries come with their own risks of complications and revision surgeries tend to have higher rates of complications than the original surgery.

It’s also interesting and important to note that each surgery has its own documented occurrences of revision surgery. Meaning, some surgeries are more prone to revision surgery later.

• Duodenal Switch surgery is the lowest with 2.7% requiring revision at some point.
• Gastric Bypass is the next lowest with 10-20% require revision at some point.
• Sleeve Gastrectomy is the highest with up to 50% requiring revision at some point.

So this means that if you’ve had sleeve gastrectomy, you aren’t alone if you’re considering a revision surgery because it tends to result in the worst long-term weight loss compared to the Duodenal Switch and Gastric Bypass.

Will insurance cover my revision surgery?

It’s difficult to say definitively since every insurance differs; however, most insurance look at revision surgery and conversion surgery as two separate cases.

Revision Surgery

Since Revision surgery deals more with complications related to the original surgery, most insurance companies will cover the revision surgery if the original surgery was covered.

Conversion Surgery

Conversion surgery will be performed because either the amount of excess weight loss wasn’t enough, or weight has been gained. There are a couple of criteria that must typically be met.

• Your BMI will likely need to be over 40 without comorbid conditions or over 35 with comorbid conditions.
• You have not been able to lose 50% of your excess weight.
• If there is documented compliance for attempted weight loss, but more weight loss is needed.

It’s important that you have this process of deciding whether conversion surgery is right for you with proper evaluation from your bariatric surgeon to make the case that it’s necessary from your insurance provider’s perspective.

Alternatives to gastric bypass revision surgery

At the end of the day, it’s advised that additional surgery be a last resort, not a snap decision or a “quick fix.”

During this process, it can be super frustrating that you’re not losing weight as you expected after gastric bypass or other bariatric surgeries, but your clinic is there to help you.

Schedule an appointment or a call with your dietitian to get back on track with your bariatric diet. It can take several weeks to months before you start to see the scale move. Remember that weight loss is not linear.

Medically Supervised Weight Loss Diet

The most available alternative to conversion surgery is to visit your bariatric clinic and see if they can put you on a medically supervised weight loss diet. This normally includes a Very Low Calorie Diet accompanied by weight loss drugs.

Nowadays there is a wide range of weight loss pharmaceuticals; however, they can be very expensive and they can have negative reactions to other medications like depression medications.

Weight loss is a process

You can’t expect to lose equal amounts of weight every single day. The fact is that the early day safer surgery is when the easiest weight to lose comes off. The more weight you lose, the harder it is to keep losing weight.

If after working with your surgeon and dietitian on non-surgical options to get back on track, then it’s time to evaluate revision surgeries as an option.

Follow your surgeon’s advice, make sure they are comfortable with your revision surgery and proceed as advised.

The bottom line on revision surgery

It’s unfortunate, but bariatric revision and conversion surgeries for gastric bypass, sleeve gastrectomy and gastric banding are common for post-op bariatric patients.

No, you can’t have gastric bypass twice, because that wouldn’t be much help. But you can convert your gastric bypass into other forms of bariatric surgery if you’re struggling with gained weight or other complications from your surgery.

Revision surgery should never be a decision made hastily. Consult with your surgeon, dietitian and support system before going under the knife again. Always try noninvasive options before surgery, but always know that revision can be a good option to restart weight loss after gastric bypass and other bariatric surgeries.