What scar tissue can make a gastric bypass too risky?

Question

Can a scar from a midline supraumbilical C-section be enough of a risk factor to suggest gastric sleeve over gastric bypass? I know OHIP only covers gastric sleeve when gastric bypass is too risky. (I'd prefer sleeve tbh.)

Jorge Maytorena, MD · Answer

Open surgeries cause scarring inside, until we enter we can know how many adhesions there are, it is considered a revision surgery, due to the history of previous surgery, but we can help you perform the sleeve or the bypass if possible.

Sandy Martinez, MD · Answer

Hi Sleepy81,Thank you for reaching out and doing such thorough research on your options!To answer your question directly: A scar from a midline supraumbilical C-section does create scar tissue, but it does not necessarily make a Gastric Bypass too risky. Instead of making the surgery inherently dangerous, the presence of this scar tissue often just makes the procedure more time-consuming. Here is the medical breakdown of why this happens:The Reality of Adhesions: Any open abdominal surgery, especially a vertical midline incision, causes the body to form adhesions (scar tissue) during the healing process. This tissue can cause the intestines or other tissues to stick to the abdominal wall or to each other.Adhesiolysis (Clearing the Path): During a Gastric Bypass, the surgeon must access the lower abdomen to bring a portion of the small intestine up to the new stomach pouch. If adhesions are present, the surgeon will perform adhesiolysis&mdash;the careful, precise cutting and releasing of that scar tissue to free the organs.
Time vs. Risk: Navigating this scar tissue is a standard part of bariatric surgery. It rarely prevents the procedure from being completed successfully. It usually means the surgery will require an extra 30 to 60 minutes in the operating room to clear the area safely before performing the bypass.What this means for your OHIP coverage and preferring the Sleeve:Because a bypass can generally still be performed safely despite the scar tissue, your surgical history alone might not be enough to classify the bypass as strictly "too risky" or medically contraindicated under strict OHIP guidelines.
However, since you prefer the Gastric Sleeve, your prior surgery is still a relevant point to discuss with your provider. The Sleeve is confined to the upper left abdomen and does not require rerouting the intestines, entirely avoiding the lower abdominal area where your C-section scar tissue is located. You can advocate for the Sleeve by highlighting your preference for a structurally simpler surgery that completely avoids your existing adhesions and reduces your overall time under anesthesia.Best regards,Dr. Sandy

Ali Solmaz, MD · Answer

Yes, your midline supraumbilical C-section scar could be considered a risk factor for gastric bypass, which might allow OHIP to cover a gastric sleeve instead. Scar tissue and adhesions from the C-section can make bypass surgery more complex, whereas a sleeve is simpler since it doesn't involve rerouting intestines. Since you already prefer the sleeve, you may be able to advocate for this option with your surgeon and get it covered.

Walfre Edwin Guerrero Burgueno, MD · Answer

A midline supraumbilical C-section scar may raise concerns about intra-abdominal adhesions or altered anatomy. 
All patients respond differently, there are those who create many adhesions to a very small surgery, and there are those who create few adhesions to large surgeries. 
Until the time of surgery it could be confirmed. But of course that there is a possibility of performing gastric bypass, if the adhesions are few, they can be removed and gastric bypass performed. Only if you have many adhesions, gastric bypass could not be performed.

What scar tissue can make a gastric bypass too risky?

Answers (4)

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