Second Weight Loss Procedure

There are two types of second weight loss surgical procedures:

1. Conversion Surgery: surgery to change from one type of bariatric procedure to a different procedure. There only two procedures that can be converted: lap band to gastric sleeve or gastric sleeve to gastric bypass. Both are then permanent.
2. Revisional Surgery: surgery to restore the effectiveness of the original bariatric procedure. Any procedure to treat failed weight loss for the gastric bypass or gastric sleeve is considered revisional surgery.

Revisional surgery options are currently considered investigational or experimental by insurance providers. Some types of revisional procedures are:

• Stoma plication
• Stomaphyx
• Rose procedure

A second operation may not be covered by your insurance plan. You will need to review your plan for your coverage information and the requirements that are necessary to be considered for a another weight loss procedure.

Indications of Failed Weight Loss Surgery

• Medical and or surgical complications or malfunction of the adjustable band or gastric bypass
• Lap band slippage
• Lab band erosion
• Port related complications
• Esophageal dilation
• Dilation of gastric pouch
• Dilated gastrojejunal stoma
• Dilation of gastrojejunostomy anastomosis

Requirements for a Second Weight Loss Surgery

To be a candidate for a second weight loss surgery, you must meet certain requirements. These include:

• The ability to demonstrate compliance with the previously prescribed postoperative nutrition and exercise program through documentation by either your primary care physician or surgeon for at least two years after the primary surgery. This information would include office visits with the surgeon, nutritionist or behaviorist; attending support groups; and keeping a journal of your weight loss journey.
• A period of at least two years since the primary bariatric surgery.
• Inadequate weight loss from the primary procedure (50% or EWL).
• If the primary procedure was successful in inducing weight loss prior to dilation of the pouch or GJ anastomosis.
• If the complications associated with the adjustable band cannot be corrected by manipulation, replacements and or adjustments.
• Your BMI is at least 35 or greater and you still have co-morbid conditions.

You will be required to complete the same program as for your first for weight loss surgery.

A second weight loss procedure requires prior authorization from your insurance provider. All insurance providers require a medical reason for requesting a second weight loss surgery. Some insurance providers are more specific than others in terms of what they will accept as a reason for not being successful with the primary weight loss surgery.

What Do I Next?

Your next step is to schedule an office visit with your surgeon. At this appointment, you will discuss the reason why your current weight loss surgery is not the best option for you. The surgeon may need to schedule you for some tests to determine the issues.

At a second office visit, you surgeon will discuss the results of any tests that may have been performed, and let you know if you are a candidate for a second weight loss operation. If you are a candidate, you can decide if you would like to move forward with a second weight loss operation.

If Your First Surgery was the Adjustable Gastic Band

If you first surgery was the adjustable gastric band system, we will remove it before you are scheduled for your second bariatric surgery. Literature shows a reduced post-operative complication rate if the gastric band removal and port removal are performed separately from the second weight loss surgery. Removal of the band requires prior authorization from your insurance company.

You can decide when to remove the band, unless it’s an emergency:

Option One: Have it removed while you are completing the program for your second procedure. If you choose this option, you will accept the risk that you may not be approved for the second procedure, understanding that replacing the band will not be an option.

Option Two: Wait until you complete the program requirements and submit all the paperwork for prior approval so you can find out if the second operation is approved by your insurance provider. We will also submit paperwork to the insurance company for prior approval of the gastric band removal. Once both are approved, we’ll schedule the procedure to remove the band and port. You will then have to wait six weeks before your second bariatric procedure can be scheduled, as long as there are no complications from the gastric band removal.