How You Know You Need a Revision or Conversion

You may have heard the term bariatric conversion or revision. This is a technical term for a secondary surgery that revises the primary bariatric procedure to either address complications or improve effectiveness and long-term weight loss. Most patients will undergo conversion, which changes the primary surgical procedure to another type of surgery (e.g., converting a gastric sleeve to a gastric bypass or a gastric sleeve to a duodenal switch). The decision to do this is based on how the patient has responded in their postoperative life, both physically and mentally. Conversions may seem like a great way to get back on track, but insurance companies will only cover patients’ conversions on a case-by-case basis – when they believe it is medically necessary. Frankly, due to the higher risk of complications after conversion, we, too, want to be absolutely sure that other reasons for weight regain are ruled out or addressed before the bariatric conversion is pursued.

Virtually any bariatric procedure can be converted. For example, it’s straightforward to convert the sleeve to a gastric bypass or revise a gastric sleeve by trimming away additional tissue for added restriction. Procedures that do not affect the structure of the stomach, like a gastric band or Lap-Band® as it is often known, are converted to other procedures without much trouble.

Typically, you can’t know for sure if your procedure needs to be converted to another surgery for continued success until you’ve had a full workup; however, we can say that the most common reason for conversion after a gastric sleeve is new or worsened reflux, which occurs in about 10% of patients, especially for those who have not had an existing hiatal hernia repaired. These cases are usually solved with surgical or endoscopic solutions or by converting to a gastric bypass, depending on a patient’s circumstance and preference.

Before considering a revision, we must discuss other problems in your post-bariatric life.

• Have you liberalized your diet over the past several months, and is that the primary cause of the weight regain? If the overeating has not gone on for too long, the stomach pouch may not have stretched, and getting back to a strict bariatric diet can help you shed pounds.
• Have you experienced highly stressful or emotional times in your life, and does this cause you to stray from your diet and exercise program? We may jointly consider employing a therapist to work with you on coping mechanisms and to stop eating and drinking to get through difficult times.
• Have you plateaued in your exercise program and need some guidance and advice on pushing through? The office staff can help develop an appropriate program that is suitable for your situation and sustainable over the long term.
• Lastly, can new GLP-1 agonist medications like Wegovy and Zepbound be enough to reverse that weight gain and get you back to your goals? If so, you can work with our team to make that a reality.

The Bottom Line

Before you choose to have a conversion surgery, please get in touch with our office and schedule a consultation to understand more about the possible reasons for weight regain. Many patients can manage their weight with some coaching and a reset and subsequently do well with a back-on-track program. However, there will be cases where a conversion or revisional bariatric procedure is necessary to maintain success and effectiveness. A consultation with our clinical team is the best way to understand if that is indeed right next for your circumstances.