Mr William Robb, Consultant Bariatric and Upper Gastrointestinal Surgeon at Blackrock WeightCare, has consistently emphasised that revision surgery should not be viewed as failure. Obesity is a chronic, relapsing disease. Surgical intervention is powerful, but long-term disease progression, anatomical factors and evolving metabolic challenges may require reassessment.

Understanding revision bariatric surgery

Revision bariatric surgery refers to a secondary procedure performed after a previous weight loss operation. This may involve:

• Conversion of one procedure to another
• Correction of anatomical complications
• Surgical management of inadequate weight loss or weight regain
• Treatment of severe reflux or nutritional complications

Revision surgery is technically more complex than primary bariatric surgery and should be undertaken in experienced, high-volume centres.

When should GPs consider referral?

There are several clear clinical scenarios where referral for specialist reassessment is appropriate.

1. Significant weight regain

Some degree of weight regain can occur several years after bariatric surgery and does not automatically indicate surgical failure. However, substantial regain — particularly when accompanied by recurrence of comorbidities such as type 2 diabetes, hypertension or obstructive sleep apnoea – warrants specialist review.

In clinical practice, revision referrals most commonly follow sleeve gastrectomy. While sleeve surgery is highly effective for many patients, a subset may experience weight regain over time or develop anatomical changes such as sleeve dilation. In selected cases, conversion to another metabolic procedure may restore weight control and improve metabolic outcomes.

GPs should consider referral when:

• BMI rises significantly above the patient’s post-operative low
• Glycaemic control deteriorates after a period of remission
• Antihypertensive or diabetic medication burden begins to increase again

Early referral allows structured reassessment, including dietary review, behavioural factors, metabolic evaluation and, where appropriate, imaging to assess anatomy.

2. Inadequate initial weight loss

A small proportion of patients may not achieve expected weight loss following primary surgery. This is again most frequently seen after sleeve gastrectomy, particularly in patients who began with higher BMI or severe metabolic disease.

In these cases, referral allows consideration of whether escalation to a more metabolically powerful procedure — such as gastric bypass or SADI-S — may be appropriate.

3. Persistent or severe reflux after sleeve gastrectomy

Gastro-oesophageal reflux disease is a recognised complication following sleeve surgery. Persistent reflux symptoms despite optimal medical therapy should prompt surgical evaluation.

Conversion from sleeve gastrectomy to gastric bypass is an established revisional strategy and can offer significant symptomatic relief in carefully selected patients.

Referral is appropriate when:

• Reflux remains uncontrolled despite proton pump inhibitors
• Endoscopic evidence of oesophagitis is present
• Barrett’s oesophagus develops or progresses

4. Complex or high BMI patients

Patients who began with BMI over 50, or those with severe metabolic disease, may occasionally require further intervention if initial weight loss has been insufficient.

Revisional bariatric surgery in these cases is technically complex and should be undertaken in experienced, high-volume centres with advanced minimally invasive or robotic capability.

Why experience matters in revision surgery

Revision bariatric surgery is inherently more complex than primary procedures. Previous surgery alters anatomy, creates adhesions and may change tissue planes. These factors require careful pre-operative planning and precise intraoperative technique.

Nutritional status, metabolic stability and psychological readiness must also be reassessed. Revision surgery is not simply a technical adjustment – it is a structured re-evaluation of a chronic disease pathway.

For this reason, revisional procedures are best undertaken in experienced, high-volume centres with advanced minimally invasive and robotic capability. Enhanced visualisation and instrument precision can be particularly valuable in complex cases where anatomy has already been modified.

Careful case selection, multidisciplinary discussion and structured follow-up remain central to safe and effective revision practice.

A collaborative approach with primary care

GPs play a pivotal role in long-term follow-up after bariatric surgery. Monitoring weight trajectory, glycaemic control, blood pressure and symptom progression allows early identification of patients who may benefit from reassessment.

Referral for revision surgery should not be interpreted as treatment failure. Obesity is a chronic metabolic condition. Disease progression, anatomical adaptation or evolving comorbidities may require adjustment of the original strategy.

At Blackrock WeightCare, referrals for revision assessment are welcomed via Healthlink. Each patient undergoes detailed review of previous operative history, current metabolic status, symptom profile and long-term goals before any recommendation is made.

The aim is always to restore metabolic control safely and appropriately.

Supporting your patients at the right time

GPs remain central to long-term care after bariatric surgery. When weight regain, relapse of diabetes or persistent reflux becomes apparent, early referral for reassessment can help prevent further progression.

Revision surgery is not about repeating the past, it is about adjusting the treatment pathway where needed.

At Blackrock WeightCare, every referral is reviewed carefully and individually. GPs can refer via Healthlink or contact the team directly to discuss a patient – 01 255 2479.

Your Health. We Care.

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That’s the wrong question.

The right question is: what does this patient need, at this stage of their disease?

Obesity is chronic, progressive, and heterogeneous. The era of picking a lane — medical or surgical — is over. The best outcomes come from building integrated pathways. Here’s how I think we could think about it clinically.

BMI 27–35: Early intervention, metabolic protection

This is where the newer incretin therapies have genuinely expanded our toolkit. For patients without advanced complications, GLP-1s can achieve meaningful weight loss and delay progression to T2DM, NAFLD, and OSA. The goal here is prevention — getting in early before the disease accumulates damage. Medication earns its place at this stage, and I use it.

BMI 35–45: The judgment zone

No dogma here. This is where clinical decision making meets outcome data.

I’ll consider GLP-1s alone when diabetes is mild or very recently diagnosed and the patient is highly adherent. Endoscopic options when they want a lower-risk bridge with 15% total body weight loss (TBWL). Surgery when there’s severe GERD, significant visceral fat, liver fibrosis, established diabetes or a poor response to medical therapy.

Often the sequence is: surgery for the durability that drugs alone haven’t matched long-term. HbA1c, reflux burden, functional status, and what the patient can realistically sustain for 20 years, cumulative cost of injectables — these also can drive the decision for surgery versus a trial of medication, not the BMI alone.

BMI 45+: Surgery anchors the pathway

The data here hasn’t changed, and it won’t be overturned by a few years of GLP-1 trial data. For severe obesity with end-organ damage — fatty liver disease, refractory T2DM, sleep apnoea, joint destruction — metabolic surgery delivers weight loss and disease remission at a magnitude we cannot replicate pharmacologically with medications available to date. Not yet. Possibly not ever, for this cohort.

That said, GLP-1s have earned a genuine role around surgery: shrinking the liver pre-operatively in very high BMI patients, reducing anaesthetic risk, and rescuing for weight regain long after the operation. They can extend what surgery starts. They don’t replace what surgery does.

What the best programs are building

Stratify by more than BMI — we need to stratify patients by metabolic burden, genetics, psychological readiness, and social context all matter. Sequence therapies deliberately and consider what the correct combinations are based on the stage of the disease. Follow patients for decades, not months. And put surgeons, physicians, dietitians, and psychologists in the same room, sharing the same data.

The tribalism between “medical” and “surgical” camps has cost patients. The win here is designing systems that deliver the right option, to the right patient, at the right moment in their disease trajectory.

That’s precision obesity care. And it needs surgeons to build it.

Your Health. We Care.

The post Knife and Needles appeared first on Blackrock WeightCare.

A common concern we hear is this – Do I need to lose weight with injections first before I can be considered for bariatric surgery?

In many cases, the answer is ‘No’.

You Do Not Always Need Injections Before Surgery

Patients with BMI above 45, and particularly those above 50, are sometimes told they must reduce weight before surgery is even discussed. This can lead to months or even years spent trying medications first.

At Blackrock WeightCare, we regularly assess and treat high BMI and complex cases. Surgery is not automatically ruled out because your BMI is high. In fact, procedures such as SADI-S are specifically designed for patients who require a stronger metabolic effect.

If surgery is clinically appropriate, it can be planned safely without asking you to invest time and money into injections first.

Each case is assessed on its own merits.

When Injections May Be Helpful

That said, weight loss injections can sometimes be useful.

They may help:

• Improve blood sugar control before surgery
• Reduce liver size
• Optimise medical conditions
• Support short-term weight reduction in selected cases

But this is strategic and individual. It is not a requirement for everyone.

Injections should never be viewed as a mandatory first step before surgical assessment.

High BMI Is Not an Automatic Barrier

Severe obesity often comes with additional conditions such as Type 2 diabetes, sleep apnoea, joint disease or cardiovascular risk. These patients need specialist input, not delay.

At Blackrock WeightCare, complex and high BMI patients are routinely assessed by Mr William Robb, an experienced Upper GI and Robotic Bariatric Surgeon. Careful evaluation determines:

• Whether surgery is safe now
• Whether optimisation is required first
• Which procedure offers the best long-term outcome

In many cases, metabolic surgery such as Gastric Sleeve or SADI-S provides more durable weight loss and stronger metabolic improvement than injections alone.

Why Expert Assessment Matters First

Starting injections without specialist advice can lead to:

• Modest short-term weight loss but no long-term plan
• Weight regain after stopping medication
• Delayed definitive treatment
• Additional financial cost

Obesity is a chronic disease. The treatment pathway should be planned properly from the outset.

An expert consultation allows you to understand:

• Whether injections are appropriate
• Whether surgery is the more effective option
• Whether a combined approach makes sense
• What is safest given your BMI and medical history

The right decision depends on your health, not on trends.

The Bottom Line

Weight loss injections can play a really positive role in obesity treatment. They are very useful tools in well selected and educated patients.

But you do not need to “prove yourself” with injections before being considered for surgery.

If you have a high BMI or complex medical history, the first step should always be specialist assessment. That way, you avoid unnecessary delay and move forward with a clear plan. Surgery and medication are very often complementary in the treatment of obesity – rather than it being the case of one or the other. 

If you would like to discuss your options, you can enquire here or speak directly with our team on 01 255 2479.

Your Health. We Care.

The post Can Weight Loss Injections Help You Qualify for Surgery appeared first on Blackrock WeightCare.

SADI-S is one of the more powerful bariatric procedures available and is designed for people with severe obesity who need more than a standard sleeve alone.

What SADI-S Means in Practical Terms

SADI-S combines a sleeve gastrectomy with a bypass of part of the small intestine. The stomach is reduced in size, and food passes further down the intestine, which creates a strong metabolic effect.

This tends to result in:

• Greater overall weight loss in higher BMI patients
• Strong improvement in blood sugar control
• Reduction in cardiovascular risk factors
• Better long-term outcomes in patients with BMI above 45

The procedure is carried out by Mr William Robb using advanced robotic and minimally invasive surgical techniques, with a focus on precision and patient safety.

Who is it Suitable For

SADI-S is generally considered for:

• Patients with BMI over 45
• Severe obesity with significant metabolic disease
• Poorly controlled Type 2 diabetes
• Patients who require substantial and sustained weight loss

This is not a routine operation for lower BMI ranges. It is chosen carefully, based on clinical need and long-term goals.

What to Expect Before Surgery

The preparation is thorough. You can expect:

• A detailed surgical consultation
• Full medical assessment and blood tests
• Review of medications and current health conditions
• A structured pre-operative diet plan
• Clear explanation of risks and long-term responsibilities

An important part of the process is psychological evaluation. This is not a test to pass or fail. It is there to ensure you are emotionally prepared for the changes ahead. Surgery alters eating patterns, routines and coping mechanisms. Understanding your relationship with food, stress and lifestyle habits helps build a safer and more sustainable outcome.

This step is about support, not judgement.

What to Expect Around the Time of Surgery

SADI-S is carried out under general anaesthesia. Most patients stay in the hospital for 1-2 days.

After surgery, you can expect:

• Early mobilisation
• A gradual transition from liquids to soft foods
• Smaller portion sizes
• Rapid early weight loss
• Regular contact with the clinical team

The first few weeks require adjustment. Energy levels can fluctuate as your body adapts.

What to Expect in the Months After

Weight loss usually progresses steadily over 12 to 24 months. Many patients experience:

• Significant total body weight loss
• Improved diabetes control, sometimes with reduced medication
• Lower blood pressure
• Less joint pain
• Improved sleep quality
• Greater mobility

Results vary, but meaningful health improvement is the goal.

Because part of the intestine is bypassed, lifelong vitamin and mineral supplementation is required. Regular blood monitoring forms part of follow-up care. The structured aftercare programme at Blackrock WeightCare supports patients for the long term, not just the immediate post-operative period.

Accessing SADI-S Surgery in Ireland for High BMI Patients from Northern Ireland

Patients in Northern Ireland with very high BMI can face limited access to advanced bariatric procedures or long waiting times. Choosing treatment in Dublin at Blackrock WeightCare allows surgery and follow-up to take place within Ireland, with regular communication with your GP and ongoing monitoring close to home.

Many patients prefer this to travelling abroad, where long-term follow-up and nutritional supervision can be difficult to maintain.

SADI-S is a serious decision. It requires commitment and follow-through. It is also one of the most effective tools available for treating severe obesity and its related conditions.

If you would like to explore whether SADI-S is suitable for you, you can enquire through our website or speak directly with our team on 01 255 2479.

Your Health. We Care.

The post What to Expect if You Are Considering SADI-S Surgery appeared first on Blackrock WeightCare.

What is Dumping Syndrome?

Dumping syndrome, also known as rapid gastric emptying, is a common side effect of some bariatric surgeries, particularly gastric bypass procedures. It occurs when food moves too quickly from the stomach to the small intestine. There are two types of dumping syndrome: early and late.

• Early dumping syndrome typically occurs within 30 minutes of eating.
• Late dumping syndrome happens 1-3 hours after a meal.

Both types have their own set of symptoms, which can range from mild to severe.

Common Symptoms of Dumping Syndrome:

1. Early Dumping Syndrome Symptoms:

• Nausea
• Vomiting
• Abdominal cramps
• Diarrhoea
• Rapid heartbeat
• Sweating
• Feeling lightheaded or dizzy

2. Late Dumping Syndrome Symptoms

• Fatigue
• Sweating
• Confusion
• Shakiness
• Rapid heartbeat
• Low blood sugar (hypoglycemia)

What Can I Do to Manage Dumping Syndrome After Bariatric Surgery?

The post How To Manage Dumping Syndrome After Bariatric Surgery appeared first on Blackrock WeightCare.

There are advantages and disadvantages to all procedures and unfortunately no magic equation or algorithm which can dictate which operation each individual patient should have. Sometimes there is a clear clinical indication that influences the choice of procedure, for example, a patient with significant acid reflux should avoid a sleeve operation. For others, the choice of operation is influenced by both patient preference and sometimes surgeon bias.

Patients often know someone who “did well’ after a particular operation and this can be a strong influence. No matter what operation you feel is right for you, it is important to discuss the advantages and disadvantages of the possible procedures with your surgeon. Of course, you may get differing opinions from different surgeons!

We’ve created a useful table to compare bariatric and metabolic treatments so you can better inform yourself of the best choice for you. If you’re still unsure, get in touch with our team and we can discuss our treatment options in more detail.

At Blackrock WeightCare we offer our patients several possibilities. While the mainstay operations remain RYGB and Sleeve Gastrectomy – both OAGB and SADI-S can be good choices for selected patients. We anticipate that the benefits of the SADI-S procedure will see it become a much more common procedure in the years ahead, particularly for those with a BMI of over 45-50. See our thoughts on why in our other blog in relation to this, here.

Ultimately, we all need to remember that surgery is not a cure for obesity. It is a fantastic treatment which must be integrated into your plan for lifestyle change. That is why Blackrock WeightCare provides all of our patients with a comprehensive follow-up program of care which includes regular contact with your surgeon, superb dietitians, specialist nurses, endocrinologists to look after your medical health, physiotherapists to advise you on activity after surgery and psychologist as needed.

Contact us to make your appointment today. We see all enquiries promptly. We will check your insurance for you and we treat all patients with openness, honesty and dignity – the core values of our team.

Your Health. We Care

The post Which Bariatric or Metabolic Operation is right for me? appeared first on Blackrock WeightCare.

Obesity is now outstripping smoking as a risk factor for many cancers. This is a startling statistic that highlights the health risks of living with obesity and the need for effective treatments. Nearly all of the evidence linking obesity to cancer risk comes from large cohort studies, a type of observational study.

An International Agency for Research on Cancer (IARC) Working Group concluded that the evidence is consistent that higher amounts of body fat are associated with an increased risk of a number of cancers.

This table summarises the risks for some common.

People who have a higher BMI at the time their cancer is diagnosed or who have survived cancer also have higher risks of developing a second, unrelated cancer.

How might obesity increase the risk of cancer?

Several mechanisms have been suggested to explain how obesity might increase the risks of some cancers

• Fat tissue produces excess amounts of estrogen, high levels of which have been associated with increased risks of breast, endometrial, ovarian, and some other cancers.
• People with obesity often have increased blood levels of insulin and insulin-like growth factor-1 (IGF-1). High levels of insulin and IGF-1 may promote the development of colon, kidney, prostate, and endometrial cancers.
• Obesity can cause chronic inflammation and this can cause DNA damage and increases the risk of

There are other possible mechanisms by which obesity can increase cancer risk.

Are many cancers due to obesity?

The proportion of cancers due to excess body weight is approximately 7% or 8% of all cancers diagnosed in high-income Western countries. 

Does losing weight lower the risk of cancer?

To better understand the relationship between weight loss among people with obesity and cancer risk, research has looked at cancer risk in people with obesity who have undergone bariatric surgery.

Studies have found that bariatric surgery among people with obesity, particularly women, is associated with reduced risks of cancer overall; of hormone-related cancers, such as breast, endometrial, and prostate cancers; and of obesity-related cancers, such as postmenopausal breast cancer, endometrial cancer, and colon cancer.

The Benefits of Bariatric Surgery

So, it is clear that obesity increases cancer risk for a broad spectrum of cancers. Weight loss reduces this risk. It is just one further way in which weight loss surgery is beneficial for improved long-term health and improved life expectancy.

Weight loss surgery is not a decision to be taken lightly but has significant health benefits for patients struggling with the chronic condition of obesity. Surgery can be a life-changing decision. It can improve not only quality of life but long-term health.

Blackrock WeightCare offers surgical treatment of obesity. Contact us to discuss your options.

Your Health. We Care.

The post Obesity and Cancer Risk – What are the Facts? appeared first on Blackrock WeightCare.

Sleeve gastrectomy and SADI-S are two commonly performed procedures and Blackrock WeightCare is currently the only surgical service in Ireland to offer patients the SADI-S procedure. In this blog, we explore the advantages of SADI-S over sleeve gastrectomy for patients with a BMI over 50.

Sleeve gastrectomy is a well-established bariatric surgery that involves the removal of a large portion of the stomach, leaving a narrow sleeve of the stomach. This procedure is known to be effective in inducing weight loss by reducing the size of the stomach and altering the hormonal signals that control appetite. However, sleeve gastrectomy is not without its limitations, especially for patients with a BMI over 50.

SADI-S (Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy) is a newer and less commonly performed bariatric surgery that combines sleeve gastrectomy with a bypass of the duodenum and the first portion of the small intestine. This procedure is designed to enhance weight loss by reducing the absorption of calories and nutrients. Recent studies have shown that SADI-S may be a more effective option for patients with a BMI over 50.

One of the main advantages of SADI-S over sleeve gastrectomy is its greater weight loss potential. A study conducted in 2018 compared the weight loss outcomes of SADI-S and sleeve gastrectomy in patients with a BMI over 50. The study found that patients who underwent SADI-S lost significantly more weight than those who underwent sleeve gastrectomy, with an average excess weight loss of 88% compared to 65% for sleeve gastrectomy. This greater weight loss can lead to a more significant improvement in obesity-related health problems such as diabetes, high blood pressure, and sleep apnea.

Another advantage of SADI-S is its lower risk of weight regain. Sleeve gastrectomy has been associated with weight regain in some patients due to the stretching of the stomach over time. SADI-S, on the other hand, involves a bypass of the duodenum and the first portion of the small intestine, which reduces the absorption of calories and nutrients. This can make it more difficult for patients to regain weight after surgery.

SADI-S is also associated with a lower risk of dumping syndrome. Dumping syndrome is a common complication of bariatric surgery and conventional roux-en-y gastric bypass surgery. It occurs when food moves too quickly from the stomach to the small intestine, causing nausea, vomiting, diarrhoea and episodes of hypoglycaemia. Patients who undergo SADI-S are less likely to develop dumping syndrome than those who undergo RYGB.

Finally, SADI-S has been shown to be a safe and effective option for patients with a BMI over 50. A study published in 2021 analyzed the outcomes of SADI-S in patients with a BMI over 50 and found that the procedure was safe and effective in inducing weight loss and improving obesity-related health problems.

So, while sleeve gastrectomy is a well-established and also a very effective bariatric operation, SADI-S may have some real benefits for selected patients with a BMI over 50. SADI-S offers greater weight loss potential, a lower risk of weight regain, a low risk of dumping syndrome and has been shown to be a safe and effective option for patients in this BMI range.

Of course, it is essential to note that bariatric surgery is a complex decision that should be made in consultation with a qualified healthcare professional. Contact us for more information.

Blackrock WeightCare. Your health. We Care

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