Revision After Bariatric Surgery

After bariatric surgery, insufficient weight loss (losing 50%> of excess weight) or weight regain may be observed in an average of 20% of patients due to different reasons. In addition, revision surgery is required for reasons such as reflux development after bariatric surgery and difficulty in feeding due to narrowing of the remaining stomach. In addition, recurrence of diseases such as diabetes mellitus, hypertension and sleep apnea treated after the first surgery may cause revisional interventions.

The most common interventions performed before revision are gastric band application and sleeve gastrectomy (tube stomach). After sleeve gastrectomy, 25-36% of patients require revision due to weight regain and intense reflux during the follow-up period. The need for revision after R-Y gastric bypass varies between 10-20%. Mini gastric bypass has been applied as a popular method recently and a need for revision is seen between 4-10%.

Before treatment, the patient’s psychiatric illness, substance use, social support level, patient compliance with treatment and whether their goals match the reality should be determined. Eating habits and compliance with the diet should be evaluated. Medical and surgical treatments should be evaluated with the patient during the decision-making process.

First of all, blood tests should be performed according to the first surgery method, and then the remaining stomach should be evaluated endoscopically. If necessary, evaluation can be done with computerized tomography.

Laparoscopic surgical interventions should be chosen as the first choice in surgery. The most frequently preferred methods in sleeve (tube stomach) and gastric band revision are Roux and Y and mini gastric bypass. Intra-abdominal adhesions after the first surgery and difficulties in re-cutting the suture line of the first surgery make revision surgery difficult. The team performing the revision surgery must be experienced, and there must be equipment and hospital conditions suitable for the second surgery.

After revision surgery, significantly more weight control is achieved according to lifestyle changes. The weight loss process after revision surgery is similar to the classical first methods. Close follow-up and dietician evaluation are definitely required after revision.