Revision surgeries are secondary surgeries performed on patients who have undergone bariatric surgery by any method before, but the targeted weight has not been reached, or the targeted weight has been reached but the patient has regained weight, or has problems related to the first bariatric surgery. It can also be called corrective or transformative surgery.

In 10% of all obesity surgeries in the world, there is a situation such as “not being able to achieve the desired result”. Losing less than 50% of the excess weight of a patient who has undergone bariatric surgery during the 18-month follow-up period is an indication of failure. In addition, regaining weight in the long term is also an indicator of failure. For this reason, bariatric surgeons recommend reoperating with a patient-specific method, considering the patient’s current medical condition and their first surgery.

First of all, it should be decided whether the patient is suitable for the revision surgery or not. The reasons for the failure of primary surgery should be examined in detail. There may be reasons related to the patient or due to the surgical technique. The patient, who is reevaluated for revision surgery, should first be consulted by a psychiatrist/psychologist and a dietitian. It is important to learn whether the patient has a stress-related eating and drinking disorder. The patient should undergo a full medical evaluation. Factors that may cause obesity surgery to fail should be identified. Finding the answer of whether the operation failed the patient or the patient made the operation unsuccessful will ensure that the “correct surgical method” is selected. UPPER GI endoscopy, passage radiographs may be requested. Routine surgical preparations such as blood tests, pulmonary function tests, anesthesia evaluation should be made to reveal the metabolic status of the patient. After the surgery decision is made, our dietitian will teach how to have a healty and correct nutrition to the patient. Afterward, the day of the operation is decided and the patient is taken to the “revision surgery” operation. The patient’s controls are performed every three months in the first year after the operation, and at the 18th and 24th months in the second year. From the third year, follow-ups are carried out annually.

In the first bariatric surgery of patients who are candidates for revision surgery, an incorrect method may be chosen or an incomplete surgical procedure may have been performed. Therefore, the preferred method for revision surgery should be chosen carefully. If someone who had sleeve gastrectomy has not lost enough weight or has regained weight; Re-sleeve or RNY gastric bypass or mini gastric bypass may be the methods of choice for revision surgery for the patients.

In revision surgery, the risks are slightly higher than in the first surgeries. While the risk of leakage or bleeding varies between 1 and 2% in primary surgeries, these risks can increase up to 3 to 4% in revision surgeries. However, being aware that the risks will not cause bigger problems than obesity and not ignoring the 96% success rate is one of the things to be considered before revision surgery.

The main problem in revision surgeries is that serious adhesions and anatomical changes occur in the abdomen due to the first surgery. Therefore, REVISION SURGERY MUST BE DONE BY VERY EXPERIENCED LAPAROSCOPIC / BARIATRIC SURGEON. Tissues that have undergone previous surgery will never be as they were in their original state. Sometimes tissue thickening and deterioration in tissue nutrition increase many risks, especially leakage. It should be preferred that a bariatric surgeon who has not completed his education in bariatric surgery yet, which means has not performed an average of 100 operations for each type of surgery, should not perform revision surgery without collaborating with an experienced surgeon.

Even gastric band removal surgery, which is sometimes thought to be a very simple procedure, is a revision surgery that may involve unexpected difficulties. In particular, mastering the anatomy of a patient who has undergone gastric resection or bypass surgery and performing revision surgery are the most difficult operations of laparoscopic surgery. However, in experienced hands, revision surgeries can be performed with a 3-day hospitalization, just like the first surgery.
Returning to daily life after revision surgeries is again similar to the first surgery process. If the patient does not have any complication, procedures can be performed to be discharged on the 3rd to 4th day. Generally, within 7-10 days, the patient can return to daily life.

Revision surgery will be examined in more detail according to the type of primary surgery below.