The Roux-en-Y gastric bypass (RYGB), once the most popular procedure, is now the second most commonly performed bariatric procedure in the U.S. behind the sleeve gastrectomy. While still considered to be the “gold standard” for surgical weight loss, it is not immune to failure, particularly in the super obese category (BMI≥50). Research shows that up to 30% of patients are unable to lose weight or experience weight regain after this procedure. (1)
At Texas Endosurgery Associates, we aim to provide patients with a comfortable and safe environment to discuss their weight loss needs. Our practice is led by the extensive knowledge and surgical skills of Dr. Ricardo Bonnor, MD, FACS, FASMBS, an internationally recognized bariatric surgeon. To learn more about Dr. Bonnor’s life-changing procedures, call his office in Houston, TX at (281) 579-5638 or let him know more about your situation by inquiring through our contact form.
How is a Gastric Bypass Performed?
To better understand how weight regain can occur with gastric bypass, it’s important to understand the intricacies of how the digestive anatomy and physiology are altered during the procedure. For RYGB, a bariatric surgeon makes several small incisions in the abdomen and utilizes various instruments- including a surgical camera- to view the stomach and the attached small intestine. Firstly, a “pouch” from the top portion of the stomach is created so that only a very limited amount of food can enter the stomach. They will then divide a portion of the small intestine and attach one end directly to the pouch. To connect these two tissues, they must create a stoma, a tiny opening that allows food to enter into the intestine. The other end of the intestine is reattached at a point further down the small intestine. Although the pouch is divided from the majority of the stomach, the stomach still produces gastric fluids to help facilitate normal digestion. With this surgery, you can digest food in an alternative manner in which you will absorb fewer nutrients since food physically bypasses a portion of the small intestine.
Why Some Gastric Bypasses Fail
Most of the time, patients don’t have any serious abnormalities, but they may have a dilated pouch and stoma, allowing more food to enter thus leading to weight regain. For others, a fistula, or an abnormal connection to the remnant stomach, can form allowing patients to consume and absorb more food and nutrients. Although gastric restriction is an important part of this revisional bariatric surgery, studies find that surgeons should also incorporate techniques to facilitate malabsorption, reducing the ability to absorb calories. (2) One approach involves converting a proximal gastric bypass- the conventional method- into a distal gastric bypass. To perform this revisional procedure, Dr. Bonnor will divide the small intestine once more in order to move it distally, or away, from the stomach. By reattaching it to a more distal location, food can bypass an even larger portion of this small intestine, increasing malabsorption. Dr. Bonnor will only consider this type of surgery in appropriately candidates for this procedure.
Am I a Candidate for Gastric Bypass Revision?
Dr. Bonnor will closely evaluate your diet habits to see if you could benefit from a gastric bypass revision. Some patients may only require diet changes to achieve lasting results, whereas others have medical complications or anatomical reasons for a secondary procedure. Dr. Bonnor will examine your digestive system using minimally invasive upper endoscopy and upper gastrointestinal contrast studies, complementary imaging procedures that will help identify the cause of your weight gain.
The upper endoscopy will provide information on the condition of the pouch and stoma. For this evaluation, Dr. Bonnor will place you under deep sedation so that a thin, flexible tube can enter through your esophagus and reach your stomach pouch to view these tissues.
An upper GI contrast study to view your esophagus and the roux limb, the portion of the small intestine that connects to the pouch. For this non-invasive form of imaging, a contrast liquid that will show up on a fluoroscopy, a type of x-ray.
At Texas Endosurgery Associates, our staff prides itself on quality service that meets the needs of each individual.
Cost of Gastric Bypass Revision in Houston
The cost of your gastric bypass revision will depend on surgical fees, anesthesia, post-operative medications, and follow-up appointments at Texas Endosurgery Associates. We accept self-paying patients as well as various PPO plans. Many types of insurance will require that you enroll in a bariatric program for a certain amount of time to earn eligibility for a revision surgery. If your insurance does not cover weight loss surgery, consider applying for medical financing that will allow you to make affordable payments to cover the associated costs. Another option is to utilize your flexible spending account (FSA) offered by most employers. This method of payment can cover up to $2,500 of the cost of your procedure tax-free, since bariatric surgeries are considered essential.
- Shah K, Nergård BJ, Fagerland MW, Gislason H. Failed Roux-en-Y Gastric Bypass—Long-Term Results of Distalization with Total Alimentary Limb Length of 250 or 300 cm. Obesity Surgery. 2023;33(1):293-302. doi:https://doi.org/10.1007/s11695-022-06388-z
- Frantzides CT, Alexander B, Frantzides AT. Laparoscopic Revision of Failed Bariatric Procedures. JSLS : Journal of the Society of Laparoendoscopic Surgeons. 2019;23(1):e2018.00074. doi:https://doi.org/10.4293/jsls.2018.00074