Chirurgia Bariatrica Revisionale in Turchia

Cos’è la chirurgia bariatrica revisionale?

La chirurgia bariatrica revisionale, o talvolta chiamata chirurgia di revisione, si riferisce a una chirurgia per la perdita di peso che corregge o migliora una precedente chirurgia per la perdita di peso, come il bendaggio gastrico, la gastrectomia a manica, il bypass gastrico o il mini bypass gastrico, che non ha provocato una perdita di peso sufficiente o ha avuto complicazioni gravi. Anche se è raro, ci possono essere molte ragioni per cui le chirurgie bariatriche non riescono a provocare una perdita di peso sufficiente e ogni pagina della chirurgia contiene maggiori informazioni su perché potrebbe non avere successo.

Le chirurgie per la perdita di peso sono generalmente molto efficaci quando i pazienti seguono le restrizioni dietetiche e fanno spesso esercizio fisico, ma in alcuni casi la perdita di peso potrebbe semplicemente non avvenire. Poiché ogni individuo è unico, a volte il proprio corpo non reagisce bene a un particolare trattamento dell’obesità.

La chirurgia bariatrica revisionale è raccomandata nel caso in cui la perdita di peso non sia ottimale, si verifichi un riacquisto di peso o siano presenti complicazioni come bendaggi gastrici rotti o spostati, problemi di deglutizione, malattia da reflusso gastroesofageo o sacca gastrica ingrandita.

 

Come funziona la chirurgia di revisione?

Qualsiasi chirurgia bariatrica può essere rivista in qualsiasi altra chirurgia bariatrica, incluso se stessa, ad esempio la gastrectomia a manica può essere rivista in una gastrectomia a manica.

 

Ogni chirurgia di revisione può essere definita dalla chirurgia che sta revisionando e dalla chirurgia in cui viene revisionata. La chirurgia in fase di revisione presenta una complessità maggiore rispetto all’esecuzione della chirurgia senza che sia una revisione, ciò è dovuto alla modifica del sistema digestivo del paziente rispetto alla precedente chirurgia bariatrica.

 

La chirurgia di revisione provoca una perdita di peso nello stesso modo della chirurgia in cui viene revisionata, e la perdita di peso attesa è la stessa.

 

Come viene eseguita la chirurgia di revisione?

La chirurgia di revisione è un intervento chirurgico più difficile e richiede una maggiore competenza rispetto alla prima chirurgia. La prima chirurgia può essere trasformata in molte diverse chirurgie con la chirurgia di revisione. Alcune delle chirurgie di revisione includono:

 

Rivisitazione della gastrectomia a manica

La rivisitazione può essere offerta quando il paziente riacquista peso dopo una chirurgia di gastrectomia a manica. La perdita di peso attesa del paziente può variare a seconda di quanto peso è stato riacquistato dopo la gastrectomia a manica. La revisione della gastrectomia a manica è molto efficace nel ripristinare la struttura del manicotto stomacale mediante il rimodellamento dello stomaco, il che avvierà nuovamente la perdita di peso.

 

Rivisitazione del bendaggio gastrico con altre chirurgie bariatriche

A causa della semplicità chirurgica del bendaggio gastrico e dell’anatomia inalterata, i pazienti con bendaggio che cercano una procedura di revisione hanno tipicamente molte opzioni. A seconda degli obiettivi del paziente, delle circostanze di salute, della storia e dell’anatomia, il paziente potrebbe poter scegliere tra una gastrectomia a manica, un mini bypass gastrico o un bypass gastrico di Roux en Y. Una volta rimosso il bendaggio, queste procedure vengono eseguite come se fossero state effettuate come procedura primaria.

 

Revisione da manicotto gastrico a bypass gastrico

In caso di gastrectomia a manica, se la sacca creata durante l’intervento è troppo grande, i pazienti avranno una restrizione inadeguata delle loro capacità alimentari e quindi una perdita di peso inferiore. Oppure, se vi è un grave reflusso acido che non viene alleviato sufficientemente attraverso i farmaci, la revisione in un bypass gastrico può essere una buona opzione. Il bypass gastrico di Roux en Y viene applicato al sistema digestivo modificato e il risultato è lo stesso di un bypass gastrico non revisionale. L’intervento comporterà un aumento della perdita di peso e una riduzione del reflusso acido.

 

Revisione da bypass gastrico a bypass gastrico

Ci sono due parti del bypass gastrico che devono essere revisionate: la sacca gastrica e la ristrutturazione intestinale, che rappresenta la parte malassorbitiva dell’intervento. Prima della revisione del paziente, verrà eseguita una endoscopia superiore, nota anche come EGD, per dimensionare la sacca gastrica. Idealmente, il chirurgo cerca di ridurre la dimensione della sacca gastrica per ottenere una migliore perdita di peso. Anche il tratto intestinale viene separato e riunito al bypass, aumentando così la lunghezza saltata dell’intestino tenue.

 

Un chirurgo bariatrico farà una raccomandazione su quale revisione sia più adatta al paziente in base alla loro storia clinica e alla perdita di peso iniziale. Contattare un coordinatore per i dettagli.

 

Come prepararsi per la chirurgia di revisione?

La preparazione per la chirurgia di revisione è simile a quella delle altre chirurgie bariatriche.

Il paziente non deve consumare cibo o liquidi nelle 12 ore precedenti l’intervento chirurgico per assicurarsi che lo stomaco sia vuoto prima dell’operazione. Prima dell’intervento, devono essere seguite anche le seguenti restrizioni dietetiche e medicinali:

 

  • L’uso di vitamina K deve essere interrotto 30 giorni prima dell’intervento poiché è un anticoagulante, ovvero un fluidificante del sangue, e aumenta il rischio di complicanze legate a sanguinamenti interni.
  • I contraccettivi orali e qualsiasi altro contraccettivo che contenga estrogeni o progesterone, come i dispositivi intrauterini, i cerotti per la terapia ormonale sostitutiva o gli impianti contraccettivi, devono essere interrotti o rimossi 30 giorni prima dell’intervento poiché aumentano il rischio di complicanze legate ai coaguli di sangue. Gli anticoncezionali ormonali possono essere ripresi 30 giorni dopo l’intervento. Gli impianti non ormonali sono sicuri e consigliati se si sta considerando un mini bypass gastrico.
  • Si consiglia di evitare di fumare a partire da una settimana prima dell’intervento fino a tre settimane dopo l’intervento. Il fumo provoca la costrizione delle vene e limita la circolazione sanguigna, potenzialmente causando complicazioni come le perdite.
  • Si consiglia di evitare il consumo di alcol nei tre mesi precedenti l’intervento. In particolare, si deve evitare il consumo di alcol una settimana prima dell’intervento poiché aumenterà il carico sul fegato e potrebbe causare complicazioni con l’anestesia.
  • Il paziente avrà una consulenza con uno specialista in malattie interne, un radiologo, un anestesista e un chirurgo generale prima dell’intervento.
  • I test preoperatori includeranno un’ecografia addominale completa, una radiografia del torace, un test di funzionalità respiratoria, un elettrocardiogramma, una valutazione endoscopica dello stomaco e un esame del sangue completo come test preoperatorio.

When should Revision Surgery be applied?

Revision surgery may be needed if the patient cannot achieve adequate weight loss, or if the patient has regained weight as a result of the operation not being performed optimally.

The first surgery can be transformed into almost any other Bariatric Surgery with revision surgery.

Do diseases such as diabetes, asthma, and blood pressure prevent revision surgery?

Patients with obesity related illnesses are evaluated by a Bariatric Surgeon and decide whether the patient is suitable or not, and similar to other Bariatric Surgeries, Revisional Bariatric Surgery will alleviate these conditions.

Will there be weight gain again after revision surgery?

Revision Surgeries are successful for most patients with regards to permanent weight loss. However, in order to achieve this success, the patient needs to make lifestyle adjustments and change their diet. It should also be known that there is no guarantee of weight loss if these are not done.

Can you have a revision after a Gastric Bypass?

If the pouch between the stomach and the intestine is found to be widened, the “passageway” can be narrowed again endoscopically during the revision operation. The revisional operation also includes the separation of the intestinal loop and it being reunited with the bypass, which will shorten the effective digestive tract.

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