Revision surgery is not an operation method or the name of a surgery. It’s the complication of a previous weight loss surgery, it’s the failure to achieve proper weight loss or after the patient’s regaining weight it’s the change of the first surgery to a different type of surgery. With the importance and prevalence of weight loss surgeries, the number of patients who need another surgery is gradually increasing. Although this rate differs in publications, it changes between 5-43%.
Most of the patients who need revision surgery are patients who can not reach their target weight since the first method is not suitable for them. The other group consists of patients who regain weight, those who repeat diabetes and those who have chronic problems due to their first surgery. Although there is no evidence-based algorithm for patients who need a second surgery, it is more effective to decide according to the patient’s clinical condition.
Gastric band application, also known as gastric banding, which is a popular method of the time, had to be changed to different methods due to the sliding of the band, enlargement of the stomach pouch, ulcer, swelling area problems and the patient’s inability to tolerate the band. While removing the band and performing revision surgery in the same session is generally preferred, in some centers, after the band is removed 6 months are waited for the revision method. As a revision method; RNY Gastric bypass, sleeve gastrectomy, bipartition procedures, SADI-S and Duodenal Switch surgery may be preferred.
Revision after stomach reduction surgery is common. In cases where the target weight can not be reached and the patient regains weight, revision should be considered, but this should be by different surgical processes, not sleeve gastrectomy. The success of performing sleeve gastrectomy again is very low due to weight gain in sleeve gastrectomy surgery. Other situations that need revision in sleeve gastrectomy are acute or chronic leaks, strictures, breaks and reflux complaints which do not respond to medication. In this case, while RNY Gastric Bypass is a good choice, in patients who gain weight or unable to reach the target weight; transit-loop bipartition procedures, SADI-S and Duodenal Switch are more effective.
Revision is also needed in by-pass surgeries and this generally has two reasons. Since adequate intestinal bypass can not be succeeded in patients who are by-passed and regain weight, a long absorption area remains and absorption defects can not completely be created in patients. The patient may not be able to reach the target weight or gaining weight may be observed again. The reverse is also possible. After the bypassed intestinal part, the remaining intestine can not provide the necessary mineral-vitamin-protein intake and people experience problems due to absorption defects. In this table which is defined as protein-energy malnutrition, the places of the intestinal connections are changed and the connections are brought closer to the stomach.
Secondary, revision surgeries are important and centers where all weight loss surgeries are specialized should be selected.