While the frequency of bariatric surgery is increasing worldwide, the need for a second surgical intervention following these surgeries, namely revisional bariatric surgery, is also increasing. Pointing to the need and thus the increase in this area in recent years, General Surgery, Bariatric and Metabolic Surgery Specialist Assoc. Prof. Dr. Anıl ERGİN said, "Patients who regain weight after bariatric surgery may have to undergo revisional surgery for different reasons. It is seen that the rate of patients who need revision can reach up to 60 percent in some studies."

What is Revision Surgery?

Defining revisional bariatric surgery as the situation where surgery is performed again for any reason after the first obesity surgery, Yeditepe University Kozyatağı Hospital General Surgery, Bariatric and Metabolic Surgery Specialist Assoc. Dr. Anıl ERGİN said that the most common reason for these interventions is weight regain, also known as "regain". In addition, he explained that problems such as reflux, postoperative complications, gastric stenosis, leakage, abscesses also brought surgery back to the agenda.

Why is Revision Surgery Performed?

Stating that the need for revisional surgery varies from patient to patient and therefore varies, our specialist continued his words as follows: "Although literature studies show that this rate varies between 5 and 20 percent, we see that this rate can be up to 60 percent in some studies. Among the reasons underlying this difference, wrong patient selection, inappropriate surgical technique and lack of postoperative follow-up play an important role. However, the rate of need for revisional surgery is very low, around 5-10 percent in clinics that apply the system properly, use the technique correctly and follow up the patient well after surgery. Therefore, these criteria are extremely important for us."

Stating that the increase in the number of primary cases in bariatric surgery has also brought revisional surgical procedures to the agenda, our expert said, "The number of bariatric surgeries, which was around 3-4 thousand per year in Turkey in 2013, has now exceeded 50 thousand. This is a really big increase. Over 500 thousand bariatric surgeries were performed worldwide last year. This number actually represents only 1 percent of the patients who need surgery. However, as the number of surgeries increases, the need for revision naturally increases."

To Which Patients Is Revision Surgery Performed?

Our specialist, who informed that reflux complaints, in addition to weight regain, are also common complaints especially after sleeve gastrectomy surgery, said, "Therefore, it becomes one of the reasons for revisional surgery. In addition, complications that may occur after the first surgery, such as leakage, narrowing, abscess, reveal the need for revisional surgical procedures."

Stating that revisional bariatric surgery is important not only for weight control but also for the prevention of serious diseases, Assoc. Prof. Dr. ERGİN said, "For example, reflux is not only a problem that reduces the quality of life; it is a condition that can damage the stomach anatomy and even lead to esophageal cancer. Therefore, making surgical corrections is also critical for the patient's quality of life." "In addition, revisional procedures will be needed as it will be vital to recover from complications, stenosis, leakage, abscesses that develop due to the first surgery. In addition, after weight loss, for example, a patient who has recovered from diabetes, his chronic diseases may return due to weight gain. Therefore, revision procedures can be considered to combat the disease."
Emphasizing that this method is not suitable for every patient, Assoc. Prof. Dr. ERGİN said, "The right surgical method should be applied to the right patient. Otherwise, reoperation may be inevitable."

Which Methods are Applied in Revision Surgery?

Informing that the most preferred method in revisional surgeries worldwide is RNY Gastric bypass, Assoc. Prof. Dr. ERGİN said, "In addition, techniques such as sleeve gastrectomy, SADI (Single Anastomosis Duodenoileal Bypass) and classical Duodenal Switch can also be applied on a patient-specific basis. As a result, there are a wide variety of cases and procedures. The important thing is to apply the right method to the right patient."

Does Revision Surgery Recur?

Pointing out that revision surgery is not a one-time intervention, Assoc. Prof. Dr. ERGİN said, "Some patients may have to undergo surgery for the second or even third time. Because revision after the first surgery can also lead to complications. Therefore, revision cases may be more risky compared to primary cases. The key point here is to evaluate the patient very well beforehand, to perform the appropriate technique appropriately and to perform the postoperative clinical follow-up as required. If these are done, the possibility of revision will decrease."

Underlining that the most important way to reduce the need for revision is to evaluate the patient well before and after surgery and to follow up continuously, Bariatric and Metabolic Surgery Specialist Assoc: "Lifelong follow-up after surgery is more important for us than anything else. Because if we want to reduce revision rates and ensure that the patient gets enough benefit from the first surgery, we have to follow this patient for life. In addition, it is possible to prevent patients from gaining weight back with weight control, diet compliance, exercise, lifestyle changes and regular endoscopic controls. However, both the patient and the physician should take responsibility together in this process."