Revision Surgery – Prof. Samet Yardimci, MD

What is revision surgery?

Whichever type of bariatric surgery is performed, there is a low risk (5-15%) of insufficient weight loss or weight regain. A second bariatric surgery can be performed in the group that regained weight after the first bariatric surgery, which is called revision surgery.

Why do I regain weight?

There may be several reasons for this. The first surgery may have been performed with an inadequate technique and a sufficient appetite reduction may not have been obtained. Another reason is that the patient may be eating very sugary and high-calorie foods. Sometimes, especially after sleeve gastrectomy surgery, indistinct stenosis develops in the middle of the stomach, and the stomach above this stenosis grows slowly over the years, leading the patient to eat more. Before deciding on revision surgery, the reasons for regaining weight or insufficient weight loss should be revealed and the treatment should be planned accordingly.

I could not succeed in the first surgery. How will I achieve success in the second surgery?

If the first surgery was performed inadequately, the second surgery will actually be complementary to the first surgery. Or, if an inaccurate type of surgery has been chosen, even if it has been performed accurately, success can only be achieved by performing the correct type of surgery. When the correct type of surgery is selected after revision surgeries, the rates of weight loss are around 90%.

I cannot follow the rules, so I regained weight. What if I do not follow the rules again?

Following the rules after bariatric surgery is essential for success. However, selection of a surgical technique with the capacity to change an individual’s eating habits is the most important factor that increases success. For example, sleeve gastrectomy surgery to be performed on an individual, who has a high-calorie and sugary diet, is eventually condemned to fail. Numerous patients, who have failed with sleeve gastrectomy, achieve success up to 90% when the treatment is converted to bypass surgery.

By whom and where is revision surgery performed?

Revision surgeries are very specific procedures requiring serious experience and skills. The physician to perform the procedure and the hospital should have all of the following qualifications.

The surgeon should be able to perform all kinds of bariatric surgery and have experience in revision surgery.
The surgeon should have experience in endoscopic interventions and the hospital should have a full-fledged endoscopy unit.
The hospital where the surgery will be performed should have an advanced intensive care unit.
The hospital where the surgery will be performed should have cardiology, endocrinology, thoracic diseases, psychiatry, and intensive care physicians, in other words, should be a full-fledged hospital.

Do diseases such as diabetes, asthma, hypertension prevent revision surgery?

On the contrary, these are diseases that are caused by obesity and will substantially improve when we treat obesity. Therefore, patients with these diseases should actually have the surgery.

Is revision surgery an open surgery?

No, revision surgeries may be performed using the closed (laparoscopic) method as in the first bariatric surgery. Probably, it will be entered through the areas used in the first surgery. So, no new scar will form.

Do revision surgeries have a high risk?

Revision surgeries are a little bit more risky operations compared to the first operation in terms of leak and bleeding. The risk of leak and bleeding is known to be 1-2% in the first bariatric surgeries, while this risk is reported as 3-4% in revision surgeries. If you see the glass half full, you will not experience any negative situation with 96% chance, but if you see the glass half empty, the risk is doubled compared to the first surgery. We should remember that the daily damage caused by obesity to the body is more than the danger of the surgery.

When can I return to daily routine after revision surgery?

Returning to daily routine after revision surgery is very similar to the first operation. If everything goes well, you are discharged after being hospitalized for 3-4 days and can return to a daily routine within 7-10 days.

What are the costs of revision surgeries? Are they expensive surgeries?

Since the hospital I work with has a contract with SSI (Social Security Institution), we can perform surgeries with lower costs compared to their equivalents. However, the costs of bariatric surgeries are slightly higher than that of other surgeries. There are several reasons for this.

The materials used are imported and expensive. There are a large variety of materials in the market. The most reliable ones are naturally the most expensive. The use of these materials specifically to the patient, single-use and disposal are essential for patient safety. Unfortunately, we hear that there are hospitals that use the same materials on several patients to reduce the cost. It is also unacceptable to compromise on patient safety to cost it cheap.
The hospital where the surgery is performed must have certain standards. An adequate number of intensive care beds and full-time physicians of all branches are required. All equipment from the operating table to the patient bed should be suitable for obese patients. Therefore, it is not appropriate to perform the procedure at every hospital.
The hospital should have a support team along with expert dietitians who are available 24 hours a day, 7 days a week.
Detailed check-up examinations and tests required for revision surgery are more costly.

Meeting all these requirements further increases the cost of the surgery compared to other surgical procedures. Compromise of these basic principles to reduce the price of surgery may result in very dangerous consequences. Another task of the surgeon is to reduce the risk. You can only feel safe in experienced hands where these conditions are met.