Discover the Top Reversible Weight Loss Surgery Options That Could Change Your Life!

Bariatric procedures are designed to promote rapid weight loss and relieve obesity-related comorbidities. These procedures work by restricting food intake and/or reducing caloric absorption. While many bariatric surgeries involve permanent alterations to the digestive system, reversible options offer a less invasive approach to weight loss. This article explores the various types of reversible bariatric procedures, their effectiveness, and considerations for those seeking weight loss solutions.

Understanding Reversible Bariatric Procedures

Endoscopic weight loss procedures are minimally invasive options for people who want help losing weight but don't want - or may not qualify for - bariatric surgery. Endoscopic weight loss procedures can achieve better weight loss than medication but not as much as bariatric surgery. Because they are newer procedures, more data is needed on how they perform over the long term.

Reversibility in bariatric surgery refers to the ability to undo or revert a weight loss system to its original pre-surgery state. In most cases, bariatric procedures that can be undone involve a foreign device inserted into the body to aid in restricting calorie intake. Some of these foreign bodies are designed to be removed at some point and can be extracted without any permanent changes to the body.

Reversible vs. Permanent Bariatric Procedures

Whether you get an endoscopic or a laparoscopic procedure, weight loss will be achieved by altering the stomach’s capacity (restrictive) and/or adjusting to the digestive tract by rerouting the intestines (malabsorptive). That is why most bariatric procedures, such as gastric sleeve and duodenal switch, are irreversible. If a procedure is not 100% reversible, returning it to its original state may cause complications.

Types of Reversible Bariatric Procedures

Several bariatric procedures offer the possibility of reversal, each with its own methodology and level of reversibility:

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Gastric Band (LAP-BAND): This laparoscopic procedure involves placing an inflatable silicone ring around the upper part of the stomach. The band limits food intake and can be adjusted or removed. Roughly 20% of excess weight loss is achieved after one year. A significant number of patients require lap band reversal due to experiencing food intolerance, slippage, erosion, port infection, and inadequate weight loss. The band is retrieved by cutting through built-up scar tissue to expose the silicone device. The surgeon cuts the band from the stomach and carefully resects it from the abdominal cavity. Reversibility: 60%
Intragastric Balloon: This endoscopic procedure involves inserting a balloon-like device inflated with gas or saline into the stomach. The balloon decreases stomach capacity, leading to feelings of fullness. Patients tend to feel a decreased stomach capacity/volume and unease when eating. The balloon comes in many different brands with an estimated weight loss of 15 to 25 lbs over a 6 to 12-month period. Individuals who experience serious discomfort, blockage, nausea, and vomiting are signs of balloon intolerance and typically require reversal. First, the surgeon deflates the balloon endoscopically. At that point, it is extracted from the esophagus and out of the mouth. Gastric balloons are rarely preserved in the body longer because the risk of deterioration and gastric damage increases over time. The balloon can be extracted sooner if requested. Reversibility: 100%
Bariclip: This laparoscopic procedure involves placing a silicon-covered titanium clip over the stomach’s greater curvature, restricting food capacity. Patients typically report an average of 20% excess weight loss in a rather short time. According to the founders of Bariclip, the procedure is alleged to be 100% reversible. Since no part of the anatomy is resected, the procedure can be reversed. Bariclip can be removed laparoscopically before if desired, or after reaching your weight loss goal. Reversibility: 80%
Endoscopic Sleeve Gastroplasty (ESG): This endoscopic procedure folds the stomach by cross-stitching sutures to shrink the gastric capacity. Around 25% of total body weight loss is reduced after 12 months. To undo this procedure immediately, the surgeon will release the cross-stitch sutures. If removed in a short time frame, the stomach can return to normal. In some cases, the stomach stabilizes into a sleeve form, causing the procedure to be permanent. It is reversible to a degree, but because of the nature of the procedure, a reversal may result in complications. Patients not reaching the ideal weight with Endo Sleeve can get a revision to a traditional VSG. Reversibility: 70%
Gastric Sleeve Plication: This laparoscopic procedure involves folding the stomach inward along the greater curvature and using staples to maintain the fold. Usually, 15-20% of weight loss is reduced from the total starting body weight. By removing the sutures and staples, the total plication reversal can return the stomach line to its original size. Long-term studies have controversial outcomes with this procedure as results vary from patient to patient. Gastric Plication can be revised to a vertical sleeve gastrectomy. Reversibility: 80%
RNY Gastric Bypass: This laparoscopic procedure helps accelerate and maximize weight loss by combining malabsorption with restriction. The reversal for RNY returns the intestines and stomach back to their original placement. Having reversion in the same area can lead to more complexities and risks of leaks, increased bleeding, infection, and scar tissue build-up. With such a demanding weight-loss operation, reversal surgery should be the last option if there are no other alternatives. Reversing a permanent surgery, such as RNY gastric bypass, is complex and requires a super surgeon. Reversibility: 10%
Duodenal Switch (BPD/DS & SADI-S): The Duodenal Switch with biliopancreatic diversion and its variation single-anastomosis DS procedure have two components:Sleeve gastrectomy to restrict the amount of food intake and separation of the biliopancreatic juices and the food to reduce the amount of nutrients absorbed. Obviously, the removed portion of the stomach cannot be reintroduced to the pouch. The second part of the operation, however, can be re-anastomosed. This reversal of switch operation is done by creating a new anastomosis between the biliopancreatic limb and the alimentary limb. Reversibility: 10%

Reasons for Reversal

Patients may seek reversal surgery due to various reasons:

Medical complications
Severe side effects
Inadequate weight loss
Malnutrition/Excessive weight loss

Risks and Considerations of Reversal

Reversible surgeries, like Lap-Band, are only in theory as they are considered impractical and often dangerous. Re-operation causes damage to the affected area and increases bleeding risks. Scar tissue can lead to longer operating times and more complex surgeries. Besides the associated dangers of reversing a bariatric surgery, you increase your likelihood of regaining back the weight or more.

Endoscopic procedures are primarily reversible; however, they are not as effective in losing extra weight and curing comorbidities. An intragastric balloon, for example, is a relatively safe and 100% reversible procedure but only suitable for patients with lower BMIs who are disciplined.

Is Bariatric Reversion Safe?

Almost all laparoscopic surgeries, such as gastric sleeve, are non-reversible.

Non-Surgical Reversible Options

Beyond surgical interventions, certain non-surgical endoscopic procedures offer reversible weight loss solutions:

Gastric Balloon: The gastric balloon may be an option for adults whose BMI is between 30 and 40. First, the doctor gives you a mild sedative. Then, using an endoscope passed through your mouth, the doctor will insert a soft, durable balloon in your stomach and fill the balloon with a saline solution. Gastric balloon is a temporary procedure; the balloon is removed after six months. Rapid weight loss is typically experienced during the first four months following placement of the balloon. In the first few days after it is placed, the gastric balloon can cause abdominal pain, nausea, and vomiting.
Endoscopic Sleeve Gastroplasty: People with a BMI greater than 30 may be candidates for endoscopic sleeve gastroplasty. Folds are stitched into your stomach to reduce its size by about 70%. This restricts how much food and drink you can consume and makes you feel fuller faster. No part of your stomach is cut or removed. Only stitches hold the folds in place. The procedure can be undone, but scar tissue may remain. Studies report that 60% of people lost about 20% of their total body weight during the first year after surgery.
Endoscopic Gastric Bypass Revision: There are times when people have trouble reaching their weight loss goals -- or even gain weight -- after gastric bypass, because of stretching that may occur at the connection between the stomach and small intestine, also known as gastrojejunostomy. In this case, we may recommend an endoscopic gastric bypass revision, which is performed by inserting a tube into your mouth to reach your stomach.

The Role of Revisional Surgery

Revisional bariatric surgery is a procedure to reverse or modify an earlier weight loss surgery. It is typically done because the earlier procedure failed in some way. It may have produced disappointing outcomes or an undesirable effect. Studies indicate that between 5 to 8 percent of weight loss surgeries fail and require revisional procedures to correct or reverse them.

Some common reasons to have revisional surgery include:

Inadequate weight loss
Weight gain
Anastomotic stricture
Stomal stricture
Difficulty swallowing
Frequent vomiting
Ulcers
Reflux
Gastric dilation or enlargement
Esophageal dilation
Band erosion or slippage
Gastro-gastric fistula
Hernia
Bowel obstruction

How the revisional procedure works will depend on the original bariatric surgery. In some cases, reversible surgery means converting one procedure to another. For instance, someone having problems with an adjustable band might have revisional surgery that includes gastric bypass. The goal of revisional surgery might be to modify the original procedure. For example, making the “sleeve” in a sleeve gastrectomy smaller.

Revisional surgery might completely reverse either a gastric bypass or an adjustable gastric band. Simply reversing the original surgery would likely lead to significant weight gain, though, so converting to a different type of bariatric procedure is often the goal.

Pros and Cons of Revisional Bariatric Surgery

Pros: Revisional surgery, when the procedure converts one form of bariatric to another, can help you avoid the significant weight gain that could reverse the original procedure. Getting revisional surgery might offer more weight loss potential if the first bariatric procedure failed. For some, though, the revisional surgery is necessary because they have problems with the original procedure.
Cons: Revisional surgery is another procedure that could come with complications such as bleeding or infection. You also are paying for a second surgery, so cost is a significant factor.

Lifestyle Changes and Long-Term Success

Like other weight loss procedures, nonsurgical weight loss options require lifestyle changes for you to achieve success. Our bariatric team evaluates your condition as well as your commitment to making these lifestyle changes.

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Successful bariatric surgery requires a team-based approach including your surgeon, dietitian, psychologist, nurse case manager, and obesity medicine specialist who will focus on taking you through each step of the journey. Patients will do better if they continue to eat healthy, engage in physical activity, keep their appointments with obesity medicine providers, and take vitamins and mineral supplements as instructed. Your bariatric care team will provide you with lifelong support to succeed and maintain a permanent healthy lifestyle including changes to your diet and regular physical activity.

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