Gastric bypass Roux-en-Y is the most common type of weight loss surgery in the US. During this operation, we use staples to create a small bag that will hold about one ounce of food at a time, so you’ll feel fuller faster and eat less food. Can you have a second gastric bypass surgery?
Gastric bypass Roux-en-Y is also a common change procedure. People who have not achieved their weight loss goals after girdling the stomach or stitching the stomach can undergo this minimally invasive procedure to lose weight.
When revision operations are needed, what are the options?
It depends on the specific life situation and initial operation. We often start with the esophagus, x-ray of the esophagus and stomach to assess the overall shape of your anatomy. After obtaining this information, we can check what options may be right for you.
The most common revision we do is for patients who previously had a circling band, an adjustable silicone band around the top of the stomach to reduce food intake.
This surgery was very popular a few years ago, but about a third of these patients now need extra surgery to lose weight because the band has loosened or slipped over time. If you are in this category, you may be a good candidate for revision of gastrectomy in the sleeve or gastric bypass.
In sleeve gastrectomy, part of the stomach is removed, and the stomach decreases, leaving the structure of the sleeve or tube. Patients eat less because of both the small size of the stomach and the change in hormones that affect appetite.
In the gastric bypass, the stomach is divided into a small upper bag that processes food and a much larger lower part that is bypassed. The small intestine is then attached to the bag. After this operation, the stomach is smaller, and hormones affect the appetite.
Hormonal changes after bypassing the sleeve and stomach make these weight loss operations particularly effective in reducing diabetes.
In bypassing the stomach, the flow of acid and bile is also redirected away from the esophagus, making it a very effective way to treat heartburn.
Endoscopic therapies for weight loss after RYGB
Endoscopic therapies rely on sclerotherapy or oral endoscopic reduction. The goal of gastrojejunostomy sclerotherapy is to reduce the diameter of the gastrojejunostomy in a minimally low-risk invasive manner. In particular, submucosal and intramuscular injections of five percent sodium Morrhuate are placed peripherally around the gastrojejunostomy to reduce the diameter of the stoma (by inducing tissue regression and scarring). Data on the effectiveness of this technique is limited. Spaulding reported a small series (n = 20) of RYGB patients who had undergone weight gain who underwent sclerotherapy.18 Although sclerotherapy was 100% effective in reducing the diameter of gastrojejunostomy, the clinical effects were marginal: from 7 to 9% of total EWL , 25 percent regained weight and only 45 percent noticed a “lasting difference”. Catalano et al. Recently reported more favorable sclerotherapy results in 28 patients with RYGB back to weight (> 18 kg after initial successful weight loss) and stoma size> 12 mm.  Injected 2 to 4 ml of sclerosant (sodium morrhuate) peripherally quadrant. Success (defined as stoma size <12 mm and loss> 75% of body weight regained) was achieved in 64 percent of patients. The mean diameter of the stoma decreased from 17 to 12.7 mm, and the average weight loss was 22.3 kg (ranging from 3 kg recovery to 37 kg weight loss). Problems encountered included shallow ulcers in the syndrome (in almost one third of patients), stoma stenosis (requiring enlargement) and pain after injection (in 75% of patients).