Revisional obesity surgeries are surgeries performed for the second time in certain cases. These surgeries are performed to correct a serious weight regain after the first surgery, inadequate weight loss or a complication (such as severe reflux, stenosis) that affects the patient's quality of life due to the first surgery. Patients should be carefully and thoroughly evaluated when deciding on revision surgery. As a result of this evaluation, whether revision surgery is required, the chance of success with non-surgical weight loss methods, the type of surgery to be performed if revision surgery is to be performed, the benefits and drawbacks of the surgery should be carefully discussed with the patient and a decision should be made accordingly.
Patient compliance after revision surgery is very important and the patient should act with full awareness at every stage of the process. Patients who have not reached a sufficient level of consciousness should not be operated if necessary.
In Which Cases Is Revision Surgery Performed?
Weight regain or insufficient weight loss: There may be some periodic weight gain in the long term after surgery. This can usually be managed with non-surgical methods. However, if the weight regain is excessive or the patient has lost very little weight after the first surgery, revision surgery may be considered in these people.
Complications after the first surgery: For example, stenosis after stomach reduction surgery (rotation of the stomach around itself, breaking in the middle) These patients usually vomit what they have eaten for a long time and this is often attributed to eating fast and large amounts of food. The diagnosis is therefore often delayed. Typically, patients cannot tolerate solid food. Therefore, their eating habits change. They turn to easily digestible (junk) foods. In such patients, revision surgery may be required to eliminate the problem. Revision surgery may sometimes be required in patients who develop drug-resistant severe reflux after the first surgery.
Which Type of Surgery is Preferred in Revisional Surgery?
After sleeve gastrectomy surgery: The most common primary obesity surgery worldwide, especially in our country, is gastric sleeve gastrectomy, which is performed over 90% of the time. The advantage of the sleeve gastrectomy is that revision is relatively easier compared to other methods since the anatomy is not disturbed (since the intestines are not tampered with). In some cases, a sleeve gastrectomy can be performed again if the stomach is extremely enlarged. Gastric bypass surgeries (mini gastric bypass or Rny gastric bypass) are mostly preferred as revision surgery after sleeve gastrectomy.
After gastric bypass: Revisional surgery is more difficult in patients who had gastric bypass surgery from the beginning. Although methods such as pouch revision (reduction of the enlarged stomach part) distalization (bypassing more small intestine) are performed, the effect is limited. Perhaps one of the most important reasons why gastric bypass surgery is not applied as the primary choice in our country is the difficulty of revision.
Revisional obesity surgeries are more complex and difficult than the first surgery. Patients should be evaluated very well before surgery. In addition, these operations should be performed by surgeons experienced in this field in experienced centers.
