Revision in obesity surgery has become a much more heard concept in recent years. ‘Revision’ is an English word and its Turkish meaning can be explained as ‘correction’. It should be noted that this word has actually been used by surgeons for years. With the increasing awareness of surgical interventions in the field of obesity, this concept has become more popular among the public.
After obesity surgeries performed in the past years, patients started to gain weight again, whether the tube stomach method or the bypass method was preferred. While this rate was around 2% in 2011, we can say that this rate increased to 20% in 2020. The rate of needing a second surgery is much higher today. For this reason, we can state that the revision brings a difficult process for those who are considering obesity surgery. We will mention what should be considered in revision surgery or which issues are important in patient questioning. But first, let’s clarify when revision surgery is performed in bariatric surgery.
When Is Revision Made In Obesity Surgery?
One of the most curious factors for those who want to have obesity surgery about revision in obesity surgery is when the second surgery is performed. First of all, it is necessary to get rid of the thought that the first surgery will definitely fail. It is necessary to wait 18 months to understand whether the first surgery was successful or not. If 40% or more of the excess weight is lost at the end of these 18 months, it means the surgery was successful. However, if the weight lost is below 40% at the end of 18 months, it cannot be said that the operation is successful. In order for the revision surgery to be planned, a minimum of 18 months must have passed since the first operation.
Why is Revision Performed in Obesity Surgery?
The 18-month period after obesity surgery is of great importance for every patient without exception. If there are some technical problems in the surgery, the patient also experiences various problems related to weight loss in this 18-month period after the surgery.
Because the problem may not only be caused by technical errors during the surgery. It should be noted that patient follow-up is also of great importance in this surgery. There may also be various problems with patient follow-up. Lack of communication between the patient and the team is also among the factors that can prevent weight loss.Sometimes the patient thinks of this surgery as a magic wand and does not change his habits in any way. In such cases, the weight loss process of the patient becomes troublesome and revision surgery may be needed in bariatric surgery.
In obesity surgery, it is also very important for the patient to change his habits, eat a healthier and more balanced diet, exercise regularly, that is, transition to a more active life. In the event that dietary habits are not changed in any way, one should not expect a successful result. In the event of unhealthy and unbalanced nutrition and maintaining a sedentary lifestyle, weight gain can be continued for a short time, besides losing weight after surgery. It should never be forgotten that nutrition is a great importance. At this point, it should be underlined that dietician control is also important.
What Should Be Considered in Revision Surgery?
Of course, revision surgery in obesity surgery means a difficult process for patients. The reason for this is that the long-term results are still not known clearly. It should be noted that even the issue of why patients gain weight after this surgery is not fully understood except for certain situations, and there is no consensus in the world on what to do.
Of course, first of all, the problems related to the surgery should be investigated in detail and put under the scope. At this point, it is necessary to underline an extremely important issue regarding revision in obesity surgery. Registration is of great importance in laparoscopic or closed surgeries. Because if you can reach the record of the first surgery, you can analyze whether there is a technical error or not. What is meant by error here is actually many factors.
There is still no gold standard in gastric sleeve or bypass methods in obesity surgery. Let’s go about gastric sleeve surgery. Even the issue of how many centimeters tube will be used in this surgical operation varies a lot according to surgeons. Therefore, the experience of the surgeon who will perform the operation should be questioned. We are of the opinion that the doctor who performed the first surgery should do the revision surgery.
Patient questioning is also an important step. The answers to questions such as when the patient has reached his ideal weight, if he has reached, how many months remained at this weight and when the patient started to gain weight must be known clearly. At this point, the following elements can be considered as procedures:
- The patient’s weight loss in the first month, 3 months, 6 months, 12 months and 18 months
- Patient’s BMIs
Patients who undergo surgery are expected to have lost 10% weight in the first month. The weight to be lost by each patient varies depending on the pre-operative weight. For this reason, it would be much more accurate to express the expected weight gain as a percentage.
Of course, we should underline that the issues such as whether the patient is psychologically supported, whether the psychological test is performed before the operation is more important than it is thought. Every patient in our clinic is subjected to this test before surgery. Because each patient should feel psychologically ready for the surgery and the next process before bariatric surgery. At this point, the psychological test is also important in terms of motivating the patients and evaluating their psychological situation.
The Importance of Hormonal Balance
One of the most important factors underlying the inability to lose weight is hormonal balance. For this reason, the hormone balance of the patient should be reviewed before surgery. Because if the hormonal balance is impaired, the patient’s healthy weight loss process will also suffer.
Are You Addicted To Alcohol? Is It Known Before The Operation?
Whether or not there is alcohol addiction is among the factors that should definitely be reviewed. Alcohol addiction can lead to obesity, and even after surgical intervention, weight loss may not occur efficiently if alcohol intake continues. In addition, one of the issues that should come to the fore regarding revision in obesity surgery is whether a sports program is made that the patient can apply after the surgery. It should never be overlooked whether the patient is being followed up and if these issues are informed before the operation.
After bariatric surgery, if the patient reaches his ideal weight and can maintain this ideal weight for 1 year, then weight gain can be controlled even with diet program. If a healthy diet program is applied consistently, the patient’s weight gain after surgery is prevented. At the same time, the medical records of patients who want to undergo revision surgery and the demands of these patients must be considered.
As a result, the issue of revision in obesity surgery needs to be handled in a multifaceted way. The underlying factor for the need for this surgery may be a technical error, not following the patient or not changing the patient’s lifestyle and eating habits. In case the underlying factor is determined, much more correct moves can be made. You can write all your questions about obesity surgery and revision surgery performed afterwards in the comment section.