Series Introduction: Revisional Operations — Which Surgery for Which Patient?

When people first decide on weight loss surgery, they often think it’s a once-in-a-lifetime operation. But for many, life after bariatric surgery is not always straightforward. Anatomy changes over time, biology continues to push back, and for some patients, new complications emerge. That’s where revisional surgery comes in.

But revisional surgery is not a “one size fits all.” Each patient’s history, symptoms, and surgical anatomy determine what kind of revision might be helpful — and equally important, when revision should not be attempted.

This new five-part series will explore “Which revisional operation is right for which patient?”. We’ll cover:

• RNY to Sleeve: for patients with relentless hunger driven by ghrelin.

• Why revisional surgery isn’t always appropriate: when weight regain alone isn’t enough reason to re-operate.

• Resleeve after failed sleeve: when it’s only worth considering, and why it rarely succeeds.

• Sleeve to MGB: for patients with ongoing insulin resistance despite good weight loss, using HOMA-IR as a marker.

• Sleeve to RNY: when reflux is the main problem.

Each article will break down the reasoning behind these revisions, and help patients understand that it’s not about “doing more surgery for the sake of it” — it’s about finding the right surgical match for the right clinical picture.