Although according to Dr. Raftopoulos’ experience bariatric surgery can have excellent results when performed by experienced surgeons, it can be associated with side effects and inadequate weight loss when the surgeon is inexperienced. Dr. Raftopoulos has a 10-year experience in USA in treating patients who had either side-effects that affect their quality of life or inadequate weight loss after bariatric surgery elsewhere.

Laparoscopic bariatric revisions are always complex procedures that differ from one to another. Despite their technical difficulties due to extensive adhesions, according to Dr. Raftopoulos’ experience bariatric revisions can be performed laparoscopically in about 80% of the cases.

1. Gastric band removal and conversion to sleeve gastrectomy or gastric bypass

2. Conversion of gastric sleeve to gastric bypass

3. Conversion of jejuno-ileal bypass to gastric bypass

4. Conversion of vertical banded gastroplasty to gastric bypass

5. Conversion of Nissen fundoplication to gastric bypass

6. Revision of gastro-jejunostomy

7. Gastric pouch resection

8. Roux limb elongation

9. Gastric bypass revision

Dr. Raftopoulos has presented his experience with laparoscopic bariatric revisions as an oral presentation at the 12th World Congress of Endoscopic Surgery and SAGES in 2010. In addition, the presentation was published at the SAGES official journal (Jangam B, O’Hara K, Bernstein B, Chhatrala R, Raftopoulos I. Outcomes of laparoscopic Roux-en-Y gastric bypass as a primary versus revisional bariatric surgery. Surg Endosc 2010;24 Supplement 1:S197-198). According to the results of this study weight loss after laparoscopic bariatric revision surgery is satisfactory but not as successful as if the same procedure was performed originally. This suggests that the choice of the original operation is very important because it offers the highest success rate.

1. The operative report of the original surgery

2. Recent barium swallow Xray

3. Dr. Raftopoulos may also need to perform a gastroscopy to evaluate the anatomy of the original bariatric procedure.