March 9, 2020

It's becoming more common for patients who've undergone weight loss surgery to return for a second procedure, according to the American Society for Metabolic and Bariatric Surgery (ASMBS), Candice Choi reports for the Associated Press.

The 3 most important considerations for patients deciding on bariatric surgery

Who's eligible for weight loss surgery?

Weight loss surgery is an effective treatment option for obesity and obesity-related conditions such as diabetes. About 40% of U.S. adults are obese and nearly 10% are severely obese, according to the latest CDC data.  

According to U.S. guidelines, patients may be eligible for weight loss surgery if they have a body-mass index (BMI) greater than 40 or if their BMI is at least 35 and they're experiencing obesity-related health issues, such as high blood pressure or diabetes.

When weight loss surgery doesn't go as planned

But while weight loss surgery can help people shed pounds, ASMBS estimates that weight loss surgery patients increasingly need repeat procedures. The organization estimates that in 2019 15% of the 252,000 weight loss surgeries in the United States involved patients who'd undergone a weight loss procedure before, compared with 6% of 158,000 surgeries in 2011.

It's unclear which weight loss procedures are leading to subsequent operations, as ASMBS does not provide a breakdown of such data. However, John Morton, a past ASMBS president and a surgeon at the Yale School of Medicine, said the patients who are undergoing a second procedure are mainly those who had received an adjustable and removable "Lap Band" that restricted the size of their stomachs.

However, ReShape Lifesciences, a medical device company that purchased the Lap Band system in 2018, has refuted that claim, saying it does not believe the lap band surgery is leading patients to seek a second surgery. Mark Watson, who performs the lap band surgery at UT Southwestern Medical Center, said patients can avoid a second surgery if the band is properly taken care of and adjusted.

Another weight loss procedure that may be contributing to the increase in second procedures is one in which a surgeon cuts away some of the stomach and inserts a slender sleeve-shaped pouch, Choi reports. The sleeve currently represents 61% of weight loss procedures. Many patients undergo the procedure because it seems less complicated and drastic to them than gastric bypass surgery, which involves stapling a patient's stomach into a small pouch and shortening their intestinal tract. However, a growing number of physicians are beginning to say the sleeve might not be the most effective treatment for patients who are severely obese, Choi reports.

Stacy Brethauer, a surgeon and former president of ASMBS, said the procedure has "been too broadly applied," even though there is only limited data on the long-term results of the procedure. He added that surgeons are beginning to notice many patients with the sleeve are returning for a second surgery.

In 2018, Anita Saah, 45, received the sleeve and she immediately lost weight but experienced severe side effects, including dehydration and vomiting bile, likely as a result of her acid reflux issues, Choi reports. Last September, Saah underwent gastric bypass surgery, her second weight loss procedure. Since then, she has not experienced any further complications. Saah said she wishes she would have known her acid reflux would have worsened as a result of the sleeve, because she would not "have had to go through two surgeries."

Kerrie Dutton, 29, also had to undergo a second procedure after getting a sleeve. Initially, Dutton couldn't overeat without feeling sick, which is expected with weight loss surgery, and she quickly dropped from 320 pounds to 220 pounds. But then her stomach began to stretch and she could eat more without feeling sick, which resulted in weight gain. In October 2019, Dutton decided to undergo a more established weight loss surgical procedure, Choi reports.

What surgeons say patients should do

Surgeons recommend patients do their research before choosing a weight loss procedure and understand what options they have available because a second surgery can increase their risks of complications.

David Arterburn, a researcher at Kaiser Permanente who studies weight loss procedures, recommended patients consult surgeons who are comfortable performing multiple weight loss operations.

Neil Floch, a surgeon, said the right procedure will depend on the patient. Floch said, "It's an individualized decision as to which surgery a particular person should have to get the best result" (Choi, Associated Press, 2/28; Stobbe, Associated Press, 3/27).

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