17
Revisional Surgery
➤ Indications for Revisional Surgery
• Inadequate weight loss or signif icant weight regain.
• Procedure-related complications such as gastroesophageal reflux
disease, strictures, dumping syndrome, and marginal ulcers.
• Nutritional complications f rom malabsorptive procedures.
• Hardware-related problems, such as band erosion or slippage.
• Progression or recurrence of obesity-related comorbidities.
➤ Common Revisional Procedures
• Conversion of AGB to SG or RNYGB.
• Conversion of SG to RNYGB or SADI-S.
• Revision of the gastric pouch or stoma in RNYGB for dilation or
weight regain.
• Conversion of RNYGB to duodenal switch or SADI-S in certain patients.
• Surgical correction of complications such as internal hernia, ulcers,
or strictures.
➤ Endoscopic Revision Procedure
• Transoral Outlet Reduction (TORe) — endoscopic suturing used
after RNYGB to reduce the dilated gastrojejunal anastomosis.
➤ Considerations in Revisional Surgery
• Increased operative time, blood loss, and risk of leak or infection.
• Detailed preoperative evaluation, including upper endoscopy,
contrast-enhanced imaging studies, and nutritional laboratory tests.
• Interdisciplinary planning and psychosocial reassessment.
• Clear patient counseling on goals, risks, and lifelong follow-up.
Bariatric Surgery Outcomes
Term Definition Example
Total weight
loss (TWL%)
Percentage of initial
body weight lost
A patient loses 40 lbs f rom a
starting weight of 200 lbs
= 20% TWL
Excess weight
loss (EWL%)
Percentage of excess
weight (above ideal body
weight) that is lost
If start weight is 250 with
ideal weight of 150 lbs
EWL = 50%
Expected
weight loss
Typical or target
weight loss for a given
procedure, expressed as
% EWL or % TWL
Gastric bypass may yield
60%–75% EWL or 25%–35%
TWL on average
Revisional Surgery
