Revision Gastric Surgery

Bariatric surgery currently recognizes as the most effective therapeutic model for the treatment of obesity and associated pathologies. However, a variable percentage of bariatric surgery may not achieve the therapeutic goal. So how do we respond to this failure?

In cases where there is no satisfactory weight loss or obesity-related pathologies not resolves, you may prefer revision gastric surgery, an intervention to prevent weight gain and promote a new weight loss. The revision gastric surgery will consider the patient’s previous surgery. For example, a gastric sleeve or gastric bypass procedure can achieve if an adjustable gastric balloon fails. In contrast, revision with a gastric sleeve or bypass requires if the laparoscopic gastric sleeve procedure fails. When a patient is re-advised for a bariatric procedure, they should receive adequate nutritional counseling and follow a careful diet retraining route. A healthy lifestyle and a proper diet are necessary for treatment.

Bariatric surgery doesn’t guarantee optimal results. Given the increasing number of procedures performed in recent years, there are more and more cases where surgery needs to replace, transformed, or restored. This varies due to inappropriate surgical indications or the wrong choice of bariatric intervention type (not all interventions and not all patients are the same!) or the patient’s carelessness in following prescriptions, ultimately a wrong surgical technique.

Revision gastric surgery is highly complex, presenting issues that only need to address in the super-specialty. It burdens a higher incidence of complications than traditional bariatric surgery, even in the best hands. This is because the presence of adhesions, foreign matter, and unusual anatomical conditions make the intervention objectively complex and exploratory.

Our experience over the years has led us to define two critical criteria for managing such complex cases. These are safety and efficiency. Our approach is based on surgical concepts and techniques specifically designed to suit these purposes. All revision surgeries feature reversibility inherent in our surgical philosophy. It also faces an advanced laparoscopic procedure according to the ideas of mini-invasiveness.

There is always the possibility of a rescue intervention, hence a re-intervention. In these cases, our surgeon listens to you with a multidisciplinary team, including a psychologist, to understand why the first intervention failed. You may have many reasons. Not moving enough, not changing your eating habits, and not following the instructions given by the team following you are just a few of them.

So, can the onset of complications after the first operation indicate revision gastric surgery?

In most cases, the answer is yes, although the answers are different. Any complications are an indication of revision gastric surgery. These complications may be early or late when they occur 1-3 months after the operation or, in rare cases, after three to several years. Surgical complications depend on the type of surgery performed and are generally independent of the procedure’s effectiveness. Non-surgical complications can result from nutritional deficiencies or, as we mentioned earlier, poor compliance with the post-operative rehabilitation pathway.

What is Revision Gastric Surgery?

Revision gastric surgery performs for various complications such as weight gain, stenosis, or leakage after bariatric surgery. The most crucial reason for revision gastric surgery procedures in Turkey is usually weight gain. Insufficient patient follow-up, incomplete information on patients, or failure to comply with this process, even if they are conscious, lie at the root of the reasons for patients’ weight gain. For these reasons, 20-30 percent weight gain observes in patients.

It is essential to choose the revision surgeries applied to the patients well. These surgeries are technically more complex and should perform by experienced surgeons. Today, with the increase in obesity surgeries, revision surgeries have also increased.

Various surgeries recommend for patients who relapse or regain weight due to diabetes, such as high blood pressure. You will determine the most accurate type of surgery after the evaluation and interview with our surgeon.

Who are Ideal Candidates for Revision Gastric Surgery?

Ideal candidates for revision gastric surgery in Turkey are all patients who have undergone bariatric surgery by any method before, can gain weight, or cannot lose enough weight. However, the way to be used in each patient is different. Therefore, not every method can apply to every patient. Again, all of these procedures can be performed laparoscopically (closed).

Our surgeon plans the treatment according to the timing and size of the problems you experience after gastric surgery. Of course, immediate revision doesn’t recommend for patients with all issues. First, the underlying causes of this problem, including anatomical, functional, and, of course, patient-related factors, should be examined, and a check should make for non-surgical corrections.

The main reason for weight gain, especially after gastric bypass surgery, is that patients cannot break their sugar consumption habits. This is usually because dumping syndrome goes away. Pouch deformations are joint when examining these patients. Dietary changes don’t help much in such patients. Prioritizing surgical correction is essential for permanent control of the problem. In these patients, we usually use the revision of the duodenal switch.

Revision gastric surgery is particular and requires deep experience and skill. Check out the ideal candidates for revision gastric surgery in Turkey in general:

• Health problems from initial surgery: If your initial gastric surgery caused a complication large enough to harm your health, you would approve for revision gastric surgery in almost all cases.
• Inadequate weight loss for medical reasons: There is no universally accepted definition of insufficient weight loss. From a medical point of view, a slimming operation is successful if the person is about 15 kg above their ideal weight after two to three years. Some people still lose relatively little weight despite a healthy diet and exercise regimen. These individuals are suitable for a second procedure. Of course, this procedure is only allowed if found fit by your surgeon.
• People between the ages of 18 and 65: As in every gastric surgery, revision gastric surgery only perform on people between the ages of 18 and 65. In other age groups, the risk of complications is so high that our doctor can decide.

What happens at Revision Gastric Surgery Consultation?

Consultation before revision gastric surgery is critical. Generally, we need a talk under the heading of pre-operative consultation to perform all kinds of operations, from therapeutic to aesthetic surgeries. Usually, in these meetings, you will discuss with our surgeon about waiting for the result, preparation for the surgery, and the type of underlying disease in case of illness. For this reason, we can say that the interviews you will conduct before surgery are the first and most crucial step.

Today, the importance of counseling before weight loss surgery has increased as the need for revision gastric surgery has increased. Complications after this type of surgery cause more fear in applicants. Therefore, knowing the surgery’s outcome and underlying diseases can effectively develop the surgery.

Before revision gastric surgery in Turkey, our doctor will tell you about this issue. In addition, the specialist will inform you about the dos and don’ts of this procedure. Our doctor in question recommends that you don’t use aspirin tablets and other drugs that cause thinning of your blood in the veins one week before the surgery. In this regard, it is necessary to know that you should only use clear liquids 14 to 48 hours after the surgery.

What are the Risks of Revision Gastric Surgery?

Although revision gastric surgery aims to eliminate the complaints that occur as a result of the first surgery, unfortunately, there are some disadvantages and health risks associated with this surgery:

• Inadequate weight loss: Fortunately, it doesn’t happen often. However, even after revision gastric surgery, it is possible that you don’t lose enough weight and therefore aren’t satisfied with the result. Fortunately, there is a lot you can do on your own to eliminate the risk of this virtually. Eat a healthy and varied diet and get plenty of exercises, even if you’re having a bad day. If your gastric balloon has been removed and a gastric sleeve or gastric bypass isn’t performed, the risk of inadequate weight loss is more significant than yours.
• Suture leakage: The risk of anastomotic leakage is higher in the revision gastric surgery procedure than in the initial surgery. This makes sense when a second procedure performs at the exact location. Anastomotic leakage can be treated and resolved quickly, even after re-operation.
• Bleeding and infections: There is a real risk of bleeding and infection in both initial gastric sleeve surgery and revision surgery.
• There is a greater chance of complications: Internal scars from the initial surgery increase the risk of complications. Faults cause less good blood flow.
• Losing too much weight: It doesn’t happen often, but some patients lose so much weight that they eventually become underweight. Therefore, always listen carefully to what your dietitian has to say.

How to prepare for Revision Gastric Surgery?

First, you should inform our surgeon in detail about your previous surgery. Instead, there should be an epicrisis about surgeries and diseases. In these patients, x-ray, medical abdominal tomography, or medical magnetic resonance imaging may be required in addition to endoscopy to better understand the anatomical changes due to previous surgeries. Before the revision gastric surgery, the following tests and examinations are performed on each patient as if they operate for the first time, except for tomography:

• Blood
• Biochemical tests
• Hemogram
• Hormone tests
• Hepatitis tests
• Whole abdominal ultrasound
• Gastric endoscopy (with anesthesiologist)
• EKG (heart x-ray)
• Chest x-ray
• Lung breathing test if needed
• Exercise test and ECO (electrocardiography)

After all these tests, our experts perform the necessary examinations. As a result of these examinations, our surgeon will first check if you have any other underlying disease that may lead to weight gain. If there is no such disease, our specialist will examine you with anesthesia like every patient. In addition, our specialist will check whether there is an obstacle to our surgery. Our relevant specialists will recommend the treatments, if necessary, before the revision gastric surgery. This way, the problems that may occur during and after the procedure are minimized.

What is the procedure for a Revision Gastric Surgery?

Generally, revision gastric surgery in Turkey is performed by laparoscopic (closed) surgery, regardless of the method. Much more important here is the experience of the attending physician. Follow the steps of revision gastric surgery procedure in Turkey:

Anesthesia

Revision gastric surgery performs under general anesthesia. Thus, you will have a comfortable and painless procedure.

Incision

Laparoscopic surgery does through multiple small incisions. The ports opened from these incisions are used for hand tools to reach the abdomen. One is a surgical telescope attached to a video camera, while the others are designed to capture special surgical instruments. The surgeon follows the surgery on a video monitor. A skilled laparoscopic surgeon with experience can perform many procedures laparoscopically, as in open surgery.

Techniques

Depending on the type of gastric surgery, the surgeon may prefer revision gastric surgery techniques:

• Gastric balloon revision: The surgeon first removes the balloon in these patients. This process can do in a single session, or the surgeon can do it in different sessions. In some patients, the balloon enters the stomach, and the surgeon may require endoscopic removal of the balloon in these patients. After removing the balloon, the specialist can perform all kinds of surgical interventions on the patient.
• Gastric bypass revision: First, when the passage between the stomach and intestines wides, the surgeon can narrow the course to three or four sessions with endoscopy and sclerotherapy. Since the food stays in the stomach longer, the patient feels full for a longer time. The intestinal loop connects to the stomach and can be separated and rejoined. In this way, the number of calories consumed decreases as fewer parts of the intestines come into contact with food. A bypass between the intestines can limit the relationship between the gut and food.
• Gastric sleeve revision: If the first operation is insufficient or the stomach enlarges again, revision surgery can perform first. Roux-en-Y (proximal) can be applied. This variant is the most commonly used gastric bypass technique and the most frequently performed bariatric procedure. It is the surgery that causes minor nutritional problems. A gastric pouch of fewer than 30 ml locates proximal to the gastric inlet. This new gastric sac has a volume of less than about one teaspoon. Creating a stomach pouch will disable the existing stomach and bring food there. It is taken from the distal part of the small intestine (colon), cut about 50-75 cm, and connected to the newly formed stomach pouch. The remaining end of the small intestine, where bile and pancreatic fluid flow, approaches 70-80 cm closer to the intestine and rejoins with the intestine.

Final

Our specialist completes the revision gastric surgery by closing the incisions. So you will be like the first day.

What are the Advantages of Revision Gastric Surgery?

Revision gastric surgery mainly do for two reasons. These are extra weight loss and fewer health problems. However, it also brings many advantages. Check out the advantages of revision gastric surgery typically in Turkey:

• Additional weight loss: When you have gastric surgery, you naturally want to enjoy the results permanently. If you haven’t lost that much weight for some reason, this could be a serious turnaround. Revision gastric surgery restarts your weight loss process and still leads to much weight loss.
• Reducing the symptoms of certain diseases: You can enjoy various health benefits after the first gastric surgery and after the repeat surgery. Patients with diabetes or high cholesterol will experience fewer symptoms as they lose more weight. It is equally possible for your symptoms to disappear completely.
• Reducing complaints from the first procedure: Some people are hypersensitive to certain foods after gastric bypass surgery. This manifests with frequent stomach and intestinal problems, belching, and vomiting. Living or living with these ailments for a long time isn’t pleasant and hurts the health of you and those around you. Revision gastric surgery in Turkey will reduce these ailments.

How is the Recovery After Revision Gastric Surgery?

During and after revision gastric surgery in Turkey, the surgeon does some tests. This test aims to determine if there are any problems with the staples and if there is a leak in the suture line. In case of leakage, the specialist places additional sutures in the appropriate places to prevent leakage. Here, too, the surgeon performs this test before taking liquid food to take the necessary precautions and make the intervention promptly:

• Putting additional sutures on unique materials called revision gastric surgery staples is controversial. Some surgeons believe that suturing reduces the chance of bleeding and leakage and that every patient should have sutures. On the other hand, some surgeons say that suturing slightly reduces the risk of bleeding; it doesn’t reduce the risk of leakage; on the contrary, it can lead to more leakage and bleeding after suturing after vascular injury. As a clinical approach, we fall somewhere between these two. Although we don’t suture every patient, we add extra stitches if we don’t think the stapling line is secure enough.
• The fact that our results are well above the world average shows that our method is more successful. The most crucial point here is that the surgeon operating should have the ability and experience to intervene and solve any problem.
• In any surgery, there is the possibility of blood clotting in the vein and occlusion of any vein. If this is a vessel that supplies vital organs such as the heart, lungs, and brain, it can cause serious problems. The risk of embolism increases with increasing patient weight. For this purpose, the doctor gives blood thinners to these patients independently of the operation. Although it slightly increases the risk of bleeding, the benefit is much more. Blood thinners begin before surgery and continue for two weeks. The duration of use may be longer in patients at high risks, such as those with cardiovascular disease or previous embolism.
• Surgeons generally prefer the laparoscopic (closed) method for revision gastric surgery in Turkey. Since the surgeon uses millimetric holes in this method, the post-intervention pain is significantly less than in open surgery. After the operation, our surgeon will give you pain relief and completely prevent your pain condition. The critical point here is this. Everyone’s pain threshold is different. Again, drug tolerance and drug bioavailability differ. Therefore, treatment cannot be standardized. Specialists tailor pain relief therapy to the needs of each patient.
• Since the incisions are tiny, the aesthetic results are also excellent. After a few months, these lines also become almost invisible. After the wound has healed, you will offer a cream to leave less scarring.
• You will start eating liquid food a few days after the revision gastric surgery. After the first two weeks of liquid feeding, soft (mashed) food give for two weeks. You will be in constant communication with our nutritionists throughout the entire process.
• You can take protein supplements for the first 15 days. Especially during the first year, the expert recommends various vitamin and mineral supplements. Depending on the operation performed, the duration of taking protein vitamins varies. These aren’t standard for every patient.
• You can take a bath after you leave the hospital. If your seams are open and wet, it’s okay. After a shower, dry with a clean towel and let it dry.
• Finally, don’t use any drug other than the ones recommended by our doctor for the first month. If another doctor guides the medicine, consult the surgeon who operated. After the first month, you can use any medication. However, try not to overuse painkillers and drink plenty of fluids after taking the drug.

When are Revision Gastric Surgery Results Seen?

The risk of weight gain after revision gastric surgery in Turkey is shallow. This shows that the results of revision gastric surgery in Turkey are successful. To benefit from this physiology at the maximum level, the patient should eat only with meals, 2-3 meals a day, and avoid snacks.

This operation also requires changing the eating habits acquired over a long period. In almost all cases, there was no increase in food capacity with weight gain in the late stages of the revision gastric surgery. Weight gain is between meals, especially high-calorie snacks. There is no known surgery to eliminate the side effects of this eating habit. In health services, safety is essential, not cost.

How Much Does Revision Gastric Surgery Cost?

The revision gastric surgery cost in Turkey varies according to many factors such as location, surgeon’s experience, techniques, materials, and facilities. However, revision gastric surgery prices in Turkey are very affordable.

Our specialists have extensive experience in revision gastric surgery. Our surgeons can perform all kinds of obesity surgeries. In addition to endoscopic examination and surgery, we also have a fully equipped endoscopy unit capacity. If you consider revision gastric surgery in Turkey, you can contact us immediately.