Revisional Bariatric Surgery in Turkey

What is Revisional Bariatric Surgery?

Revisional bariatric surgery or sometimes known as revision surgery, refers to a weight loss surgery that corrects or improves a previous weight loss surgery, such as Gastric Band, Gastric Sleeve, Gastric Bypass, or Mini Gastric Bypass, that did not trigger enough weight loss or had major complications. Even though it is rare, there could be many reasons Bariatric Surgeries can fail to trigger enough weight loss, each surgery’s page contains more information on why it could fail.

Weight Loss surgeries are typically very effective when patients follow their dietary restrictions and often exercise, but in some cases weight loss may simply not happen. As each individual is unique, sometimes their body does not respond well to a particular obesity treatment.

Revisional Bariatric Surgery is recommended in case the weight loss is not optimal, weight is regained, or complications such as ruptured or displaced gastric bands, problems swallowing, Gastroesophageal reflux disease, or enlarged gastric pouch are present.

How Does Revision Surgery Work?

Any Bariatric surgery can be revised it any other Bariatric surgery, including itself, i.e. Gastric Sleeve can be revised into Gastric Sleeve.

Each revision surgery can be defined by the surgery it's revising and the surgery it's revising into. The surgery being revised poses a higher complexity compared to performing the surgery without it being a revision, this is due to the patient's digestive system being modified from the previous Bariatric Surgery.

The revision surgery triggers weight loss the same way as the surgery it revises into, and the expected weight loss is the same as well.

How is the revision surgery done?

Revision surgery is a surgical intervention that is more difficult and requires more expertise than the first surgery. The first surgery can be transformed into many different surgeries with revision surgery. Some of the revision surgeries include:

Gastric Sleeve to Gastric Sleeve Revision

Resleeve can be offered when the patient regains weight after a Sleeve Gastrectomy surgery. The Patient’s expected weight loss can vary depending on how much weight was regained after the Sleeve Gastrectomy, Sleeve Gastrectomy revision is very effective at restoring the structure of the sleeve by reshaping the stomach, which will reinitiate weight loss.

Gastric Band to Other Bariatric Surgery Revision

Due to the surgical simplicity of the band and unaltered anatomy, band patients seeking a revisional procedure typically have many options. Depending on the patient’s goals, health circumstances, history, and anatomy, the patient may be able to choose between having a Sleeve Gastrectomy, Mini Gastric Bypass, or Roux en Y Gastric Bypass. Once the band has been removed, these procedures are done as they would be if done as the primary procedure.

Gastric Sleeve to Gastric Bypass Revision

Most commonly, if the pouch created during Gastric Sleeve was left too large, patients will have an inadequate amount of restriction on their eating capabilities, and therefore will have less weight loss. Or if there is a severe acid reflux that is not alleviated sufficiently through medicine, revision into Gastric Bypass is a good option. The Roux En Y Gastric Bypass is applied to the modified digestive system, and the result is the same as a non-revisional Gastric Bypass. The surgery will result in increased weight loss and reduced Acid Reflux.

Gastric Bypass to Gastric Bypass Revision

There are two parts to the gastric bypass that is to be revised: the stomach pouch and the bowel rearrangement, which is the malabsorptive portion of the surgery. Before the patient's revision, an Upper Endoscopy, also known as an EGD, will be performed to size the stomach pouch. Ideally, the surgeon tries to revise the stomach to a much smaller pouch to provide a better weight loss. The intestinal loop is separated and reunited with the bypass as well, which will increase the skipped length of the small intestines.

A Bariatric surgeon will make a recommendation for which revision is the most suitable for the patient depending on their health history and initial weight loss, contact a Patient Coordinator for the details.

How to Prepare for Revision Surgery?

Preparations for revision surgery is similar to that of other Bariatric Surgeries.

The patient should not consume any food or liquid 12 hours before the surgery in order to make sure the stomach is empty before surgery. The following dietary and medicinal restrictions have to be followed before the surgery as well:

  • Usage of vitamin K should be stopped 30 days before surgery as it is an anticoagulant, i.e. blood thinner, and increases the rate of complications associated with internal bleeding.
  • Oral contraceptives and any other contraceptives that have estrogen or progesterone, like coils, HRT patches, or birth control implants, must be stopped or taken off 30 days before the surgery as they increase the rate of complications arising from blood clots. Hormonal and oral contraceptives can be used 30 days after surgery. Non-hormonal implants are safe and recommended if considering a mini gastric bypass.
  • Smoking should be avoided starting a week before surgery until three weeks after surgery. Smoking causes the veins to constrict and limits blood circulation, potentially causing complications such as leakage.
  • Alcohol consumption should preferably be avoided in the last 3 months leading up to the surgery. Alcohol consumption a week before surgery should especially be avoided as it will increase the burden on the liver and might cause complications with anesthesia.
  • The patient will have a consultation with an internal diseases specialist, radiologist, anesthesiologist, and a general surgeon before the surgery.
  • Preoperative tests at the hospital will include full abdominal ultrasound, chest x-ray, breath functioning test, electrocardiogram, endoscopic investigation of the stomach, and full blood test as pre operation test and exams.

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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