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Inadequate Weight loss and Weight Regain

Posted On : May 24, 2016

There were numerous causes for the inadequate weight loss and or weight regain after weight loss surgery.

These factors may include:
1-Type of the surgery: Duodenal Switch, RNY, Adjustable Gastric Banding, Intragastric Balloon, etc.
2-Patients metabolic state (age, activity level, hormones state etc)
3-Co-morbidities
4-Patient compliance
5-Other

Each and every one of these may be an independent factor or may be a contributing cause.

In our experience, patients non-compliance is not as common as others believe. Frequently, we see patients in our office where they have been told that the poor outcome of the surgery is “their fault”
We see this with RNY, and Band patients as well as some of the duodenal switch patients who are seeking advice for weight regain or inadequate weight loss.

I would like to talk about the issues of inadequate weight loss or regain post Duodenal Switch specifically. Duodenal switch operation as described by Dr. Hess, outlined the division of the small bowel lengths to be proportional to each and every patients own total bowel lengths. This meant that two patients with the same BMI and weight will end up with two different lengths for common and alimentary limbs if there total length of the bowel is different. Unfortunately, too often patients are given a “standard”  or “set” ( not clear what that word means, since there is no established standard in the literature) length for common channels and alimentary  channels regardless of the total small bowel length. In some patients, those lengths may result in acceptable weight loss. However, quite frequently a patient with a preselected length for the common and alimentary limbs will end up either loosing too much weight and have nutritional problems or not loose adequate weight. As with all practices, we have over the years had patients who have had nutritional deficiencies and excessive weight loss or have had inadequate weight loss. Looking at the raw numbers however, we have had more patient from other practices that have come to us for revisions and corrections of lengths of the bowel lengths from other practices that our own patients have required.

Another level of the confusion is the improper interchanging of the “SIPS and SADI” procedures with the duodenal switch operation. As I have said in the past repeatedly, SIPS and SAID are not the same as the duodenal switch- and attempt to call these different procedures the same is misleading to say the least.

The other category of weight regain or inadequate weight loss includes medications and new health issues.  Discussed in a previous blog, there are many medications that can influence weight gain.  It is important to work with your health care provider to find medications that have a positive effect on symptoms without added side effects whenever possible.

In summary, weight re-gain or inadequate weight loss can have many facets.  However, surgical technique can provide an advantage.  Each aspect should be addressed and identified.

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