Bariatric surgery includes procedures for the treatment of obesity and obesity-related health issues. But sometimes patients might not have the desired results in the first surgery. In this case, revisional surgery is required.
With bariatric surgery procedures, patients are expected to lose weight in a certain period and to sustain this weight loss. Otherwise, the operation is unsuccessful. Revisional bariatric surgery is an effective method to reverse this chart.
Revisional surgery is not only performed for weight loss but also to eliminate health issues such as type 2 diabetes. Some clinical researches show that with revisional bariatric surgery procedures, there are improvements in type 2 diabetes cases.
When is revisional surgery operated?
In some weight loss surgery cases, revision might be needed. Revisional bariatric surgery cases are listed as follows.
- After obesity surgeries, it is aimed for patients to lose at least 50% of the excess weight in 1-1.5 years. If the patient lost less than 50% of the weight in 18 months after the surgery, a second surgery is recommended.
- After the surgery, if the patient is gaining weight after weight loss, revision is a good option.
- If there are certain complications after the first operation, revisional surgery might be an option.
- Revisional surgery is a good option when the gastric band is not well-tolerated and caused certain issues.
- Again, a second surgery is required when the sufficient section of the stomach is not removed or the stomach got bigger after sleeve gastrectomy.
In addition to that, information about the patient’s first surgery and the post-op process should be collected when choosing a revision method. Any problems in the first surgery, total weight loss after the surgery, pre-op and post-op food consumption and calorie intake changes, post-op weight gaining and whether weight loss is tried with an expert dietitian and hormonal problems of the patients are important for the second surgery decision. Additionally, it is necessary to know the current eating habits, alcohol usage frequency and whether the patient exercises regularly.
What are the revision surgery methods?
The path in revisional surgery should be determined based on the first bariatric surgery.
Revisional surgery after gastric band Patients with a gastric band who have not had successful results might have new laparoscopic stomach band or gastric bypass or gastric sleeve surgery.
Revisional surgery after gastric sleeve If the patient gained weight after sleeve gastrectomy surgery, two different revisions are preferred. First one is roux en y gastric bypass method. Another option is to repeat gastric sleeve surgery and make the stomach smaller again. With roux en y gastric bypass surgery, a small stomach sac is created at the entrance. This way, food directly enters this new small stomach sac. Thus, patients can feel fuller with less food. Then, some part of the small intestine is cut and connected to the new stomach sac.
Revisional surgery after gastric bypass Sometimes revisional surgery might be necessary because of larger stomach sac or increased sac after gastric bypass surgery. When there is enlargement between the transition from the stomach to the intestine, this could be decreased with endoscopy. Since there is no need to make any cuts, patients can recover fast with this method. The connection between intestine and stomach can be separated and connected further and this section might contact with less food. Again, the intestine bypass is possible for the same purpose.
Is revisional surgery risky?
Revisional surgery is performed by an obesity surgeon in a hospital environment with the laparoscopic method. But the risks in every surgical operation are also there for revisional surgery.
The main risks are bleeding, embolus, infection and anesthesia reaction complications.
Some factors play a key role to minimize the surgery risks and to have successful results. For example, the surgeon must have the experience, the hospital must be equipped and all the medical tools and devices must be technologically advanced.
Recovery after surgery
The recovery after revisional surgery depends on the procedure, patient’s age and general health status but it is slower than the first bariatric surgery. The recovery after the second operation might take 4 to 6 weeks.
If the revisional surgery is laparoscopic, recovery is faster but if it is open surgery, recovery is longer.
As in the first surgery, hospitalization for the second surgery is between 2 to 4 days.
Patients might experience stomach pain in the following weeks. In this case, the surgeon gives painkillers to the patient.
Additionally, physical therapy might be recommended to some patients during recovery.
Following the medication treatment and diet program recommended by the surgeon in this period both accelerates recovery process and reduced post-op complication risks.
Full recovery after revisional surgery takes a few months.