REVISION OBESITY SURGERY

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Obesity is a health problem that is rapidly increasing in the world as a pandemic. Today, obesity surgery comes to the fore as the most effective and permanent treatment of obesity. Obesity surgeries have also been one of the most common surgeries in the world. This is directly proportional to the number of people with obesity problems and the demand for surgery. About 10 years ago, Gastric Bypass Surgery was the most common obesity surgery performed in the USA and Europe, while Gastric Sleeve Surgery has been performed more frequently than Gastric Bypass surgery in recent years. While the discussion of which surgery is more suitable for obesity patients continues, the concept of revision obesity surgery has now emerged.

Revision literally means revising or correcting something. The term surgical revision means to correct a previous surgery for different reasons or to convert it to another operation.
Why those who have obesity surgery may need revision surgery?

First of all, the reasons for revision  obesity surgery can be listed as follows:
- Excessive weight loss
- Weight gain
- Severe vitamin deficiencies
- Eating disorders due to anatomical problems such as torsion (chronic vomiting)
- Persistent chronic diarrhea that cannot be relieved with medication
- Uncontrolled hypoglycemia and nesidioblastosis
- Internal hernias
- Severe gastro-esophageal reflux disease

Although the above reasons are the main reasons that require revisional obesity surgery, other reasons can be added to this list.
 

First of all, it should be noted that due to the increase in the number of obesity surgeries, the number of revision obesity surgeries is also increasing and will increase. However, obesity surgeries are of more than one type and there is no such thing as the best obesity surgery, what we want to say here is that tube gastric surgery is appropriate for an obesity patient, while Gastric Bypass Surgery may be appropriate for another, that is, all characteristics of the patient should be taken into account when making the decision of surgery. there is no patient. So the treatment should be personal. To summarize, the wrong choice of surgery also increases the risk of obesity revision surgery.

Another factor that increases the risk of revision surgery is wrong or inadequate surgical technique or experience. Naturally, as the surgical experience increases, the results of the surgeries become more satisfactory. In this respect, the competence of the surgical team also affects the risk of revision that may be required in the future. For example, the fact that the fundus of the stomach, known as the appetite center, was not completely removed during the stomach reduction surgery affects weight regain rates. Another factor affecting the rate of obesity revision surgery is the surgical technique. For example, if the surgeon fixes the stomach istaple line to the fat tissue called omentum, after sparing enough time and removing the excess stomach during sleeve gastrectomy, the incident called stomach torsion is much less common and the problem of vomiting in the early and late periods after the operation is much less. we see.

Again, the disposable materials used in a serious surgery such as obesity surgery should be of very high quality and should be used only once, otherwise the risk of various complications in the early postoperative period will increase.

The first of the two most important factors that increase the risk of obesity revision surgery is the wrong patient selection and the second is the wrong surgery choice. To give an example of wrong patient selection, we can say the following; For example, if a patient who has developed sugar addiction for emotional reasons is not treated or controlled before the surgery, the risk of weight regain will be very high. Again, if patients with significant hormonal disorders are not detected before surgery, the results of the surgery will be sad. Operation of patients who have a smoking addiction problem and who openly express that they cannot quit smoking will also increase the risk of complications such as stomach leak in the early period and may lead to the need for revision surgery.

The wrong choice of surgery is also a very important factor that increases the risk of obesity revision surgery. For example, treating a patient in the early stages of obesity without any additional disease such as type 2 diabetes, severe reflux esophagitis disease and diabetes dependence with gastric bypass surgery instead of a simpler and physiological surgery such as sleeve gastrectomy will increase the risk of revision surgery in the long term. We know that obesity patients who do not have type 2 diabetes before surgery but who are treated with gastric bypass surgery can develop persistent hypoglycemia (nesidioblastosis) in the long term, which creates the need for revision surgery. However, the opposite may also be the case, for example, treating a type 2 diabetic super-morbid obesity patient with severe sugar addiction with metabolic surgery or gastric bypass surgery instead of gastric sleeve surgery is very much in terms of long-term weight loss, weight loss and treatment of type 2 diabetes. it will be more accurate and effective.

As we mentioned at the beginning, revision obesity surgery is the correction of a previous obesity surgery or turning it into another obesity surgery. The two most common obesity surgeries are sleeve gastrectomy and gastric bypass surgery. For example, if the previous tsleeve gastrectomy surgery is corrected again for various reasons, that is, if the enlarged stomach is reduced again, it is called Re-Sleeve Revision surgery. The perivios surgery of a patient who has undergone sleeve gastrectomy for different reasons can be converted to gastric bypass, which is also an example of obesity revision surgery.

A patient who had a previous gastric bypass surgery may also need to be corrected for bypass surgery. We call this Stomach Bypass revision. More rarely, it is revision surgery performed on gastric bypass patients who develop dangerous problems such as persistent chronic hypoglycemia, severe vitamin deficiency and chronic diarrhea. In this case, gastric bypasses are broken and the suregry can be converted into a sleeve gastrectomy. Although this technique is a more difficult surgery, we can do this. The operation for the conversion of gastric bypass into a tgastric sleeve surgery is called Reversal to Normal Anatomy Revision Surgery.
Again, patients with previous gastric band may get their lap band removed and converted to sleeve gastrectomy or gastric bypass, this is also an example of revision obesity surgery. 

In the calculations made, it is seen that in the near future, the need for obesity revision surgery will develop in 1 out of every 5 people who have obesity surgery. The result is the following; Surgeons dealing with obesity surgery should have the surgical technique, experience and training to perform revisions. In the very near future, obesity revision surgery operations will constitute an important part of obesity surgeries. For this reason, choosing the right technique, the right patient, the right surgery is very important, and informing the patients about revision surgery will make them more conscious. Thus, the risk of revision surgery can be reduced.