Conversion to Other Weight Loss Operations

Re-banding

If you have had a technical mishap with the band, such as a slipped band or erosion of the band, it is often possible to “re-band”. If the band has slipped out of position at the top of the stomach an operation to re-position the band is usually possible. Sometimes it’s as simple as just putting the band up to the correct position but occasionally a new tunnel underneath the stomach needs to be made or a new band placed. If the stomach is swollen and “unhappy” it may be better to remove the band temporarily and replace it down the track when things have had a chance to settle down.

If you have an erosion of the band into the stomach, it is best to simply remove the band altogether. This is because there is always infection around the band at the time of erosion which will not go away unless the band is removed. Re-banding six or more weeks after band removal for erosion is possible but it is generally recognized that there is a high chance of another erosion if you have already experienced it once. It is worth considering the possibility of conversion to sleeve gastrectomy or gastric bypass at this point or even no further intervention at all.

Re-banding in the setting of slipped band or erosion is more difficult and dangerous than the original band placement due to scar tissue from the previous surgery

Conversion to Gastric Bypass

It is possible to remove the band and convert to gastric bypass. This may be considered if you have had a technical problem with the band or if you have failed to lose a significant amount of weight. Having a bypass after a band is more dangerous than just having a bypass up front because of the scar tissue left behind on the stomach from the band. The chance of getting a leak from gastric bypass surgery is probably more than 5% after you have had a previous band. In addition to this is it possible to get bleeding or liver damage during the surgery because of adhesions and scar tissue related to the band surgery itself.

Outcomes after converting bands to bypasses are usually not quite as good as having the bypass up front. This may be due to the fact that the second operation is compromised somewhat because of the altered anatomy or may be due to the same reasons that weight loss was difficult with the band in the first place, e.g. poor food choices.

We like to wait at least six weeks after band removal before performing a revisional bypass to ensure that the stomach and surrounding tissues have a chance to recover from the chronic stricture of the band and be in as healthy condition as possible. We will usually undertake a gastroscopy test and contrast swallow to delineate the anatomy as best possible before proceeding. Sometimes it may be necessary to perform manometry on the oesophagus which takes about one hour and involves a catheter probe down into the stomach. This is to check that the oesophagus is still functioning well after being subjected to high contraction pressures over many months or years due to the restriction of the band.

Conversion to Sleeve Gastrectomy

Another possibility is to convert the band into the newer sleeve gastrectomy. Again, the problem of scar tissue at the top of the stomach is there and the staplers used to create the sleeve will have to go through the scarred up area. This means that the leak rate from sleeve gastrectomy after banding will be higher (around 5-10%) than having a sleeve gastrectomy up front (around 2%). There are no accepted guidelines as to who should have a sleeve gastrectomy and who should have a bypass after a band and mostly this will come down to the individual’s choice.

One point of view is to acknowledge that both sleeve and bypass have a relatively high complication rate when done after banding and perhaps it is better to end up with a bypass rather than a sleeve if you are going to take this risk in the first place.

Conversion of Sleeve Gastrectomy to Gastric Bypass

Sleeve gastrectomy has only been studied for up to five or six years as a primary operation for morbid obesity.  It is felt that a small amount of late weight regain is possible for many people after three years or so, just as in any of the other bariatric procedures.  In some cases, this may be due to expansion of the gastric tube as a response to chronic pressure or overfilling.  In some circumstances it may be appropriate to convert the sleeve into a gastric bypass down the track to allow weight loss to continue.  Other reasons for conversion of a sleeve into a bypass include obstruction or twisting of the gastric tube or even severe acid reflux.  A gastric bypass should essentially eliminate reflux. 

Conversion of the sleeve into a bypass involves transecting the gastric tube to create the gastric bypass pouch.  The small bowel "Roux limb" is then joined to the upper pouch of the sleeve to form the bypass.

Conversion to Biliopancreatic Diversion

Conversion to a Scopinaro-style biliopancreatic diversion is a revisional operation after the band which avoids the scarred-up area around the top of the stomach. This operation is based on forced malabsorption of calories by severely shortening the amount of bowel available for absorption of food and nutrients. Unfortunately the operation has significant up-front and long term risks with mortality rates often >1-2%. Protein and nutrient deficiency is not uncommon down the track and can sometimes be quite severe.

We do not offer this operation as a revision currently because of its severe complication profile.