REVISIONAL (CORRECTION) BARIATRIC SURGERY
Revisional bariatric surgery or correction surgery in obesity; By definition, it is defined as situations in which an intervention to prevent obesity has been made before, but needs to be intervened again for certain reasons. The incidence of revision bariatric surgery among patients is in the range of 6-8%. Revision surgeries generally take longer and require more surgical skills. In general, the hospital stay of the patient is 3-4 days on average, while the duration of the operation varies between 1 and 3.5 hours depending on the procedure.
You may ask why do I need revision bariatric surgery? The answer is that you haven’t lost enough weight (which means 25% of your overweight), technically not suitable for you in the first place, or you have problems due to surgical complications.
The reasons for revisional bariatric surgery can be varied. Some examples are as follows:
- The patient does not follow the warnings of his dietician and doctor after obesity surgery or non-surgical interventions.
It is very important for the patient to comply with all the rules given after obesity surgery, not to regain weight and to spend his next life in a healthy way. For example, high-calorie liquids, such as hot chocolate, coke or alcohol, may mean that the entire procedure is wasted if the consumption is excessive after the surgery. Or, such as consuming solid foods during the period when liquid nutrition is required.
- Failure to choose a suitable treatment model for the patient and the patient’s values.
For example, if a patient with type 2 diabetes also has a weight problem and a gastric band is inserted instead of gastric bypass, it means that a suitable treatment method has not been determined for the patient. Or, the same thing may be that a patient with a body mass index of 42 needs to undergo tube stomach surgery, but an intervention that results in insufficient weight loss may have been performed by recommending gastric botox or balloon.
The surgeon and his team are under the learning on their procedures, it means they do not have enough experience to perform these procedures.
It is not enough for the surgeon and his team to just say we are doing this job. The number of surgeries and patient satisfaction in the area deemed suitable for you are very important in this regard. It also determines whether the method chosen is suitable for you. In addition, the feedback you will receive before the operation, postoperative 1st month, 3rd month and 1st year will be important in understanding the total success of the surgeon and his team.
- The emergence of the risks of complications unique to the operation.
These can be very diverse. If we look at the revision surgeries needed after various primary surgeries:
Revision after Sleeve Gastrectomy (Tube Stomach)
Back Weight Gain or Not Enough Weight Loss
Although sleeve gastrectomy is one of the most effective methods in losing weight, it has been observed that some patients have difficulty in losing weight in the range of 5-10%.
Stomach Leaks
Stomach leaks are often unpleasant scene. It is hoped that it never happenes. For this, it is very important to consult an experienced team. If there is, treatments can be tried without the need for surgery. If it is sufficient, a surgery called Gastric Bypass or Roux En Y (RNY) may be recommended.
Increased Reflux
It can be observed in 20% of patients. While most of them can be treated with medication, low rates of surgical intervention may be applied.
Stomach Stenosis and Vomiting
Examinations, the patient’s history, and accompanying diseases require the surgeon to decide how much the stomach will be narrowed within a certain range. Making a wrong judgment here or skipping information may cause the stomach to be narrowed. And this can mean that stomach stenosis and vomiting increase with it.
Stomach enlargement
In the postoperative period, it is a situation where the stomach grows again due to the inability to get support from the dietician and surgical team or only because the patient does not comply with the rules given. It may result in regain of the weight lost after a certain period of time.
Can I have “Revisional Sleeve Gastrectomy” after sleeve gastrectomy?
Yes, you can. So nothing is irreparable. For certain reasons, the situations listed above may have occurred. This does not mean that you will spend the rest of your life like this. Everything can be fixed with the right team and in the right hands.
If you ask if I can undergo revision surgery after gastricbaypass( RNY) the answer is yes. The main reasons for revision are as follows:
If you haven’t lost enough weight,
If metabolic disorders due to malnutrition such as vitamin deficiency, hypoglycemia and hypocalcaemia have occurred.
If an ulcer has occurred,
If stenosis has occurred due to anastomosis,
If dumping syndrome has developed,
If there is a loss of weight to harm health,
Revision surgery after “Adjustable Laparoscopic Tape”:
Not losing enough weight
The damage of the band on the stomach wall
The band moves towards the middle of the stomach and is not in a planned place.
Esophagus enlargement
The onset or increase of reflux.
Revision after Vertical Band Gastroplasty:
This type of surgery is outdated and not preferred anymore. It can be operated as revision surgery. The place where the old punch line is located is the topic that need more attention.
Please do not hesitate to ask the following questions to the centers you apply for revision surgery:
I know that a more difficult surgery is waiting for me, so is the team that will operate me experienced in this field?
How many revision surgeries did they do in 1 year?
Will my condition be examined with imaging tests such as endoscopy and tomography before the operation?
Will a dietitian determine what kind of nutritional mistakes I made before the operation?
You don’t need to be afraid. Yes, revisional bariatric surgery is more challenging and risky than having bariatric surgery done for the first time, but when it is done by expert hands, there is nothing to fear. Moreover, you will question why you did not have it earlier or regret that you did not have surgery in the hands of these experts in the first place. You are the most important decision maker of a healthy life.
