Which patients is revision surgery performed on?

On people who have already had obesity surgery but have not achieved the result they need: because of weight regain, insufficient weight loss after a sleeve or bypass, or complications of a gastric band. The cause of the failure is first studied in depth in order to choose the best option.

How much does revision surgery cost?

Removing a gastric band without further surgery costs €5,400. If the operation is changed because of failure, the price is the same as that of the operation to be performed. The 2-year multidisciplinary follow-up costs €950.

Who can have diabetes surgery?

People aged 25 to 65, with a BMI between 29 and 40 and type 2 diabetes diagnosed less than 10 years ago, who need more and more medication or insulin or have poor control despite treatment. The indication is always individual.

What technique is used in diabetes surgery?

Currently, the SADI-S-type technique: a gastric sleeve with a single connection between the duodenum and the ileum. It is more physiological than the classic bypass and carries a lower risk of iron, folic acid and vitamin B12 deficiencies.

Which is better, the balloon or surgery?

It depends on the individual assessment, BMI and associated conditions. The balloon is preferable with a BMI below 35 and no associated conditions; bypass, in severe obesity with diabetes or a BMI over 45.

Is the gastric balloon uncomfortable?

Nausea is common in the first few days and improves with medication. After that, what you mainly notice is a lack of appetite and a feeling of 'something' in the stomach.

Will I feel hungry when the balloon is removed?

No. The stomach stretches back gradually and there is no feeling of emptiness when it is removed.

How long does the balloon stay in?

The swallowable balloon, about 4 months; the endoscopic balloon, 6 or 12 months. Follow-up with the team lasts 1 year.

Can I regain weight after the balloon?

Yes. It can only be avoided by keeping up the habits learnt during the treatment.

Can a second balloon be placed?

Yes, after waiting 3–4 months, although it is usually less effective than the first.

Why don't you perform gastric plication any more?

Because it has fallen out of use due to its limited long-term effectiveness and high rate of weight regain. For moderate obesity there are options with better results, such as the gastric sleeve.

Is the Apollo method surgery?

No. It is an endoscopic procedure, although it is performed under general anaesthesia in an operating theatre. We do not currently perform it: we have replaced it with less invasive medication treatments.

Is the Apollo method permanent?

No. Its restrictive effect lasts up to about 18 months; after that, the stitches come loose and the stomach returns to its size. That is why it is key to use this time to change habits permanently.

What is the difference between the Apollo method and laparoscopic gastric plication?

Laparoscopic plication is performed laparoscopically: it first frees the greater curvature of the stomach and creates a double fold with permanent stitches, so it is considered permanent. The Apollo method is performed by endoscopy, does not free the greater curvature and is temporary.

Obesity treatment • Clínicas Obésitas

Revision surgery

This is surgery for people who have already had obesity surgery but have not achieved the result they need. Every operation has a certain failure rate, which is low when the patient has been properly assessed, the operation is well chosen and the recommendations are followed. Because of its complexity, it should only be performed by a well-established, specialised team.

When it is needed

Weight regain after obesity surgery.
Insufficient weight loss after a gastric sleeve or gastric bypass.
Complications of a gastric band.

The preliminary assessment

The first step is a multidisciplinary assessment to identify why the previous operation failed. Depending on the case, the options considered are restoring the original operation (more common with bypass), changing technique (more common with the sleeve) or removing the band and changing technique.

What options are there?

Previous operation	Situation	Revision option
Gastric band	Band complications	Laparoscopic removal of the band
Gastric band	Initial BMI below 45, no frequent snacking or sweets; lost weight but regained it	Band removal and gastric sleeve in a single operation
Gastric band	Initial BMI above 45, with frequent snacking and sweets; lost little or no weight	Band removal and gastric bypass in a single operation
Gastric sleeve	Very high initial BMI, over 55	Conversion to SADI-S bypass
Gastric sleeve	Larger stomach capacity after years of overeating	Conversion to gastric bypass
Gastric bypass	No feeling of fullness and greater intake capacity over the years	Adjustable gastric band over the bypass stomach
Gastric bypass	Snacking, frequent sweets and disordered eating	Conversion to long-limb bypass, with more malabsorption

A gastric band should be checked at least every 3 years, or sooner if vomiting or discomfort occurs, and should only be adjusted by a specialist. After removal without further surgery, the hospital stay is about 24 hours and normal life resumes in about 48 hours.

How it is performed

Preparation: multidisciplinary assessment (can be done remotely), pre-operative diet, exercise, optimisation of medical treatment, pre-operative tests and appointments with the anaesthetist and the surgeon.
Operation: laparoscopic, with minimally invasive anaesthesia, in a single operation, taking 120–150 minutes in theatre. It is performed by Dr Ferrer and his team, following ASMBS recommendations.
Fast Track protocol: no ICU; the patient gets up and walks after 2 hours, drinks fluids within a few hours and is discharged in 24–48 hours, depending on their progress.

Recovery and follow-up

Daily walks and an active but relaxed life.
Liquid diet in the first week, progressing to a normal diet by 4 weeks.
Skin stitches removed after 7–9 days and return to work in 7–9 days.
Do not lift more than 15 kg for 4–5 weeks.
24-month multidisciplinary follow-up with surgeon, dietitian and psychologist, including nutritional blood tests.

Cost

Gastric band removal without further surgery: €5,400.
Change of operation due to failure: the same price as the operation to be performed.
2-year multidisciplinary follow-up: €950.

Prices for the Valencia and Madrid clinics. They include pre-operative assessment and preparation, laparoscopy with the Fast Track protocol, surgical team fees, hospital costs, hospital follow-up and an emergency phone line. Specific preparatory tests are not included. Financing available for up to 5 years.

Diabetes surgery →

Gastric balloon

This is a balloon placed inside the stomach that takes up part of its volume to create a feeling of fullness and help control food intake. It is a minimally invasive procedure, with no surgery and no hospital stay. Its effectiveness depends on a multidisciplinary programme and on the patient's motivation to change their habits. We have treated more than 500 patients with this technique.

Types of balloon

Endoscopic balloon

It is placed by endoscopy under sedation, in about 15–20 minutes and without a hospital stay.
It is filled with up to 700 cc of saline.
It is removed by endoscopy after 6 or 12 months, or sooner if the expected weight is reached or two months go by without weight loss.

Swallowable balloon

It is swallowed as a capsule with sips of water, under X-ray guidance, without sedation or endoscopy.
It is filled with 550 cc of saline.
It stays in place for about 4 months: its valve opens at around 16 weeks and it passes out naturally in the stool.

How it works

It produces early satiety and reduces portion sizes.
It slows stomach emptying, so the feeling of fullness lasts throughout the day.
It helps reduce cravings between meals and breaks the hunger–anxiety–hunger cycle.

Who is it for?

Patients with a BMI between 30 and 34 who have not succeeded with non-interventional methods.
Who are willing to change their eating habits and lifestyle.
Compared with surgery, the balloon is preferable with a BMI below 35 and no associated conditions.

How it is performed

Preparation

Stomach protector during the previous 5–7 days, as prescribed by the doctor.
Liquid diet for the previous 24 hours and 8 hours of fasting.

Placement and removal

Placement: through the mouth, under sedation administered by the anaesthetist, in about 10–20 minutes. The balloon is filled with saline and methylene blue. No hospital stay is required and the patient goes home, preferably accompanied.
Removal (endoscopic balloon): by endoscopy under sedation, in about 10 minutes. The balloon is emptied and removed through the mouth.

The first days and diet

The first 24–48 hours are a period of adaptation, supported by medication.
Nausea is common in the first 2–3 days and improves with treatment.
During the first 3 weeks, food texture progresses: rehydration in the first 48 hours, then liquids, purée and a soft diet.
From the first month, a healthy diet guided by the dietitian and adapted to the stomach's reduced capacity.

Multidisciplinary follow-up

For 12 months: medical follow-up by the bariatric surgeon, dietary follow-up by the dietitian and cognitive behavioural therapy with the psychologist, with a 24-hour helpline and clinical and ultrasound monitoring.

Results and outcomes

Our own study

520 patients, mean age 35.1 years (77.7% women / 22.3% men).
Mean initial BMI: 34.7 kg/m². At 18 months: 30.2 kg/m².
The balloon is very effective between months 1 and 4; its effect is smaller in months 5 and 6.
Two years after removal, those who achieved the expected weight loss regain between 5% and 10% of the weight lost. Those who do not achieve it tend to regain weight more easily.

Possible discomfort and effects

Nausea in the first few days; after that, mainly a lack of appetite and a feeling of "something" in the stomach.
In the long term there may be some stretching of the stomach, especially the fundus, which generally recovers to a large extent with no functional impact, although it can worsen a hiatus hernia.

Weight is only maintained if the habits learnt during the treatment are kept up.

Cost

Endoscopic balloon	Valencia	Madrid
Up to 6 months	€3,700	€3,800
Up to 12 months	€4,500	€4,600

Includes prior assessment, fees, 24-hour helpline, balloon, hospital costs, ultrasound or X-ray monitoring if needed and multidisciplinary check-ups for 12 months. Financing available for up to 5 years.

← Diabetes surgery Gastric plication →

Obesity treatment

Discover the best treatment for you

Discover the best treatment for you

Highly specialized clinic in:

Our data is backed up

20

Mortality rate

Extensive experience in:

Multidisciplinary follow-up by an expert team

Plastic surgery after obesity

Other surgeries

How we organize an operation

Patient Resources

What treatment do I need?

Revision surgery

When it is needed

The preliminary assessment

What options are there?