3 Reasons for Weight Regain after Bariatric Surgery

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Significant number of obese people may regain the lost weight after variable length of time post-surgery. Weight regain after bariatric surgery occur due to many factors that range from failure to sustain dietary plan, inadequate exercise/physical activity to sustain a healthy weight.

Weight loss surgery has been said to be a means to an end and not the end itself. They must be complemented with healthy diet/dietary habit as well as other lifestyle adjustments such as increased physical activity/exercise. Without these, regaining the already lost weight is inevitable.

Weight regain after bariatric surgery is often accompanied by worsening of the comorbid conditions such as hypertension, diabetes mellitus, dyslipidemia, sleep apnea. The overall quality of life reduces as the patient regains the already lost weight and the risk of death rises as the weight increases.

Weight regain after bariatric procedure depends on the type of procedure. While patients who had duodenal switch hardly regain weight, almost all patients who had intra-gastric balloon device placement will regain at least some of the lost weight after the removal of the balloon.

Nevertheless, even among patients with the same bariatric procedure, it is difficult to predict those that will regain weight. The following are the causes of weight regain:

Pouch Dilatation

Reducing the stomach capacity is one of the major mechanisms of inducing weight loss by most bariatric surgeries. While the stomach is reduced to a tubular structure (approximately 10-20% of its original size) in gastric sleeve surgery, a pouch of about 30mls capacity is created to serve as the functioning stomach (with the remaining larger portion rendered useless) in gastric bypass surgery. A similar mechanism is used in gastric banding by partitioning the stomach into a smaller functioning upper part and a larger lower part that only serve as a conduit. In intra-gastric balloon device, the placement of the balloon reduces the space within the stomach leading to early satiety.

The reduction in stomach capacity reduces appetite (reduction in the production of an appetite hormone gastrin) as well as food intake (as the stomach gets full with ingestion of little meal). To sustain the low appetite and early satiety, the size of the stomach must remain the same, even years after weight loss surgery. This is often difficult for most patients to sustain due to relaxation in their dietary plan after losing appreciable weight.

To prevent pouch dilatation, adherence to dietary plan plays a central role. Eating must stop immediately the sensation of fullness is felt. Eating and drinking should not be done simultaneously but at least 30minutes apart. Alcohol and carbonated drinks should be avoided after gastric sleeve surgery.

bariatric surgery failure

Inadequate Exercise

Exercise is energy consuming. This energy comes from biomolecules such as carbohydrate, fat and protein. With exercise, considerable amount of fat can be burnt. This is why most surgeons will want to see convincing evidence that the patient has commenced exercise targeted at reducing weight before surgery, as this may be a pointer to the likelihood of sustaining such exercise after surgery. Failure to sustain exercise at a level that prevents weight gain, and possibly promote weight loss after bariatric surgery, is a cause of weight regain.

Preventing weight regain therefore involves exercise (aerobic, muscle building as well as strength training exercise). A target must be set. The goal is to start small and increase the intensity and duration of the exercise gradually till a healthy weight is achieved. Following the attainment of a stable and healthy weight, the exercise must continue at a level that prevents weight gain. This can be determined by working closely with your dietician and trainer who will calculate your basal metabolic rate, your daily calorie intake and determine the level of exercise that helps you burn excess calorie.

Gastro-gastric Fistula/Widening of the Stoma

In gastric bypass surgery, the pouch (functioning stomach) is separated from the remainder of the stomach (bypassed stomach) by staples. An abnormal connection between the pouch and the bypassed stomach through the staple line (gastro-gastric fistula) is a long-term complication of gastric bypass surgery. Similarly the opening between the pouch and the small intestine known as stoma may become wider with time. These two conditions abolish the restrictive component of gastric bypass surgery leading to increased food intake and weight regain.

Weight regain after bariatric surgery can be resolved by evaluating the cause and addressing it. However some causes may require a revision surgery in order to correct them and achieve satisfactory weight loss. The choice of revision surgery depends on the primary bariatric surgery as well as the cause of weight regain. Below are the revision surgeries for common weight loss procedures.

Gastric Banding

Revision surgeries for gastric banding include re-banding, conversion to gastric sleeve, conversion to Roux-en-Y gastric bypass or conversion to duodenal switch. The choice depends on the cause of weight regain. Some people even make the decision to remove the band altogether. It is truly important to determine the failure cause before making a decision to go about converting to another bariatric method. If you struggled with adhering to the nutritional and exercise guidelines, then it is likely that you will struggle with the other bariatric surgeries as well.

At this point, it is important to discuss all of your questions with your doctor so that they can come up with the best course of action. Make sure you are honest with them so that they can provide you with the best care and suggest a new method to help you lose or maintain weight.

Gastric Sleeve Surgery

Revision surgeries for weight regain after gastric sleeve surgery are re-sleeving, conversion to gastric bypass surgery or conversion to duodenal switch. The choice depends on the cause of weight regain. Before you get any type of revision or conversion you will have to be evaluated to determine the cause of the initial surgery’s failure. Surgeons will want to make sure that the next surgery will be successful. It is important to note that revisional surgeries carry higher risks than the initial procedure, so it is essential that you consider those before making any decision.

Recovery from a second procedure is going to be more expansive and complicated than your initial surgery. It is advised that you adhere to the strict dietary guidelines, exercise and even nutritional supplements.

Gastric Bypass surgery

Gastric Bypass revisional options include the addition of Lap-Band, lengthening the Roux limb, use of sclerotherapy, trans-oral outlet reduction and conversion to duodenal switch. The choice depends on the cause of weight regain.

Nevertheless, after any of these revision surgeries, dietary plan and healthy eating habits must be followed to prevent pouch dilatation. Exercise must continue at a level that induce weight loss or maintain a healthy weight. Joining a support group or a weight loss forum may be of help in ensuring dietary and exercise compliance. Working closely with your surgeon and dietician will go a long way in preventing weight regain.

failure at bariatric surgery

Weight Regain After Bariatric Surgery

To be honest, experiencing weight gain after bariatric surgery is actually a common problem among bariatric patients. This phenomenon is typically associated with dilation of the stomach pouch over time, as well as insufficient physical activity. Most people will see success if they adhere to the dietary guidelines and exercise frequently, but we get how that can sometimes be difficult.

Thankfully, there is an option for patients who start regaining their weight after the bariatric surgery and that is a revision. Revisional bariatric surgery offers a second chance for patients to achieve their weight loss goals – as long as they address the reasons behind the weight regain.

It is important to go through extensive and a comprehensive evaluation to determine the root cause of the weight regain in order to have better success the second time around. Patients who combine surgical intervention with a renewed commitment to lifestyle changes have a good chance to be more successful.

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