Obesity is a complex disease that is increasing all over the world. Obesity, which is caused by being overweight, causes many diseases along with it. Moreover, some diseases such as hypertension, heart attack or various types of cancer can lead to serious life-threatening diseases. Thanks to bariatric surgery methods, weight loss can be achieved in patients who cannot lose weight with regular exercise and healthy nutrition. However, patients need to completely change their diet and daily habits after surgery and adopt a new lifestyle. In cases where this lifestyle cannot be changed, the inability to lose excess weight causes the surgery to fail. Failures can also occur due to the application itself, but this is extremely rare.
Although bariatric surgery is the most effective and successful solution in the treatment of obesity, there is a small margin of failure as in all operations. There may be multiple reasons for failure after bariatric surgery. Complications after the surgery, use of the wrong technique, or the patient's failure to follow a balanced diet and regular exercise program after the surgery may lead to obesity again. If the patient cannot lose the desired amount of weight or starts to gain weight again, the operation is considered unsuccessful.
Revisional bariatric surgery is the second operation performed on patients who have previously undergone bariatric surgery, but cannot lose weight at the targeted rate for various reasons or regain the weight they lost. Revision surgery can be performed after all bariatric surgery applications such as sleeve gastrectomy, gastric clamp, duodenal switch or gastric bypass. In cases where the first surgery is unsuccessful, the patient has a great responsibility in order to obtain a successful result after the revision surgery. The technique to be preferred in the revisional bariatric operation usually varies according to the technique in the first operation. However, a different technique is preferred in revision surgery than the technique used in the first bariatric surgery.
As in bariatric surgery operations, revisional bariatric surgeries can be performed with the laparoscopic method. However, the rate of open surgery is higher in revision applications. In case of various complications such as adhesions in the surgical area after the first operation, revision surgery should be performed openly. However, the possibility of choosing open surgery in revision operations is extremely low.
Revisional surgery may be required in approximately 5% of patients who have had bariatric surgery. After bariatric surgery, patients are expected to lose approximately 75% of their excess weight within 1 year. Adhering to a balanced diet and regular exercise program applied after the surgery is extremely important in losing excess weight. However, it is very difficult for some patients to get used to this new lifestyle. In patients who go out of the nutrition program or do not adopt an active lifestyle, sufficient weight loss does not occur, and weight gain may occur again.
Losing less than 25% of the excess weight or regaining weight after the first surgery indicates that the surgery was unsuccessful. However, failure may occur as a result of a mistake made in the surgery, choosing an unsuitable surgical technique for the patient, or a complication after the surgery. Revisional bariatric operation is required when such situations are encountered.
In truth, revisional bariatric surgery is very similar to other types of bariatric surgery. In essence, it is a question of selecting a different method. As a result, it is not seen as more harmful. Revision operations, on the other hand, take longer than the first procedure. However, there is an increased risk of problems during and after operation. As a result of this condition, revision procedures are viewed as riskier. Revision operations, on the other hand, have a lower likelihood of success. When revision surgery is conducted by a skilled and expert physician, it is possible to get extremely good outcomes.
However, not everyone may be suitable for revision surgery. Revision surgery is decided by considering the complications that develop due to the first surgery, the general health status of the patient, the conditions that may cause weight gain again or prevent weight loss. As before the first surgery, patients should undergo a psychological evaluation before revision surgery.
Recovery after revision surgery might be more difficult than recovery from the original procedure. The patient, on the other hand, should discover exactly what went wrong after the initial surgery and what steps he or she must take following the revision operation. These information are crucial in deciding whether or not to have revision surgery.
Revisional bariatric surgeries do not have any inherent harm. However, as with all other surgical operations, it carries some risks. Depending on the first bariatric surgery, the likelihood of these risks may increase even more. The risk of complications in revision applications is higher than in the first operation. Adhesions or scar tissue in the abdomen may increase the risk of complications. In addition, some risks such as gallstones, dumping syndrome, leakage and gastritis, which are also present in the first surgery, are also present in revision surgery. In addition, the risks of any type of surgery such as bleeding, reaction to anesthesia, coagulation or infection are also present in revision surgery.
There are more than one revision surgery as well as more than one bariatric operation. The technique to be used in revision surgery varies depending on the technique in the first surgery.
According to the researches, the technique most frequently requiring revision surgery is gastric band surgery. Revision surgery may be needed due to the slipping or wearing of the clamp. In some cases, tightening the clamp is sufficient. However, revision surgery is usually required by removing the clamp. In cases where gastric banding fails, gastric bypass or sleeve gastrectomy surgery is preferred. In case of excessive scar tissue formation in the area after gastric band surgery, it may be necessary to wait a few months after the cuff is removed to perform the revision surgery.
The stomach is an organ that may expand greatly, and while it can be controlled by surgery, expansion is still a possibility. The bypassed small intestine size can be enlarged with another gastric bypass procedure if the first one fails. A gastric band, on the other hand, is utilized when the stomach has to be shrunk.
Revision after sleeve gastrectomy is slightly different from other techniques. In patients who have had sleeve gastrectomy surgery, a condition called acid reflux, characterized by the reflux of stomach acid into the esophagus, may occur. However, as in the gastric bypass method, the tube stomach can expand over time, allowing patients to eat more, leading to weight gain again. In case of chronic acid reflux after sleeve gastrectomy surgery, gastric bypass technique is preferred in revision surgery. In cases where the stomach is enlarged, tube stomach surgery can be performed again and the stomach can be reduced again. After gastric sleeve surgery, leakage may occur from the part where the stomach is joined. In cases where this leakage cannot be controlled, revision surgery is required. Roux-en-Y gastric bypass method is generally preferred in cases where leakage cannot be controlled.
