43848 Revision, open, of gastric restrictive procedure for morbid obesity, other than adjustable gastric restrictive device (separate procedure)

Name of the Procedure:

Revision, open, of gastric restrictive procedure for morbid obesity, other than adjustable gastric restrictive device (separate procedure)

Summary

This procedure involves surgically revising a previous gastric restriction surgery used to treat morbid obesity. It does not involve adjustable gastric bands but rather modifies other types of gastric restrictive procedures.

Purpose

This surgery addresses complications or failures from a previous gastric restrictive procedure aimed at treating morbid obesity. The goal is to correct problems, improve weight loss outcomes, and mitigate any adverse effects experienced from prior surgeries.

Indications

• Insufficient weight loss or weight regain following previous gastric surgery
• Complications such as gastric obstruction, pouch enlargement, or severe acid reflux
• Specific patient criteria include a BMI indicating morbid obesity and failure of non-surgical weight loss methods.

Preparation

• Patients may need to fast for a certain period before surgery.
• Medication adjustments may be necessary.
• Pre-operative assessments, including blood tests, imaging studies, and nutritional evaluations, are usually required.

Procedure Description

1. The patient is given general anesthesia.
2. The surgeon makes an incision to access the stomach.
3. The previous gastric restrictive procedure is located and assessed.
4. Necessary modifications or repairs are performed—this may involve reshaping the stomach, removing scar tissue, or altering previous surgical constructs.
5. The incision is closed with sutures or staples.
6. The patient is monitored as they recover from anesthesia.

Duration

Typically, 2-4 hours, but it may vary based on complexity.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Surgeon specialized in bariatric surgery
• Anesthesiologist
• Surgical nurses
• Supporting surgical staff

Risks and Complications

• General surgical risks: infection, bleeding, and adverse reactions to anesthesia
• Specific complications: leakage from staple lines, blood clots, malnutrition, and gastrointestinal issues
• Rare risks: damage to surrounding organs and severe infections

Benefits

• Improved weight loss and management
• Resolution or improvement of obesity-related conditions (e.g., diabetes, hypertension)
• Enhanced quality of life
• Benefits may be noticed within a few months post-surgery.

Recovery

• Hospital stay: 1-3 days
• Gradual reintroduction of diet, starting with liquids and progressing to solid foods
• Regular follow-up appointments to monitor progress and address any complications
• Full recovery may take several weeks, with restrictions on physical activities initially.

Alternatives

• Non-surgical weight loss methods: diet and exercise programs, medications
• Other bariatric surgeries: adjustable gastric banding, gastric bypass
• Alternatives may have different risks and benefits; some may be less invasive but also less effective.

Patient Experience

• The patient will be under general anesthesia during the procedure and will not feel any pain.
• Post-operative pain and discomfort are managed with medications.
• Gradual improvement in mobility and comfort as recovery progresses.
• Emotional and psychological support may be beneficial throughout the recovery process.