Revision Surgery

Revision Surgery in Turkey

What is Revision Surgery and Who is It Applied? 

Revision Surgery in TurkeyToday, the most rational and effective way to fight obesity, morbid obesity, super and hyper obesity is Bariatric Surgery. Surgical procedures that vary according to the person’s lifestyle, eating habits and comorbid diseases are the most reliable approach for the patient to step into a quality and healthy life.

As we always say, the purpose is; It is to give people “new habits” after surgery. They should radically change their eating habits and make physical activity a part of their lives.

Sometimes things don’t go as expected. At this point, “Revision Surgery” comes into play.

Although it is low in all obesity surgeries, there is a possibility of gaining weight again. By applying a second surgical procedure to these patients, if they regain the weight they have gained, and if they stop losing weight, weight loss can be started again. All of these secondary procedures are called revision surgery.

Which Patients Is Revision Surgery Applied?

It can be applied to all patients who have previously undergone obesity surgery by any method and regain weight or cannot lose enough weight. However, the method to be applied to each patient is different. Therefore, not every method can be applied to every patient. Again, all of these procedures can be done laparoscopically (closed) method.

When should Revision Surgery be applied?

After your obesity surgery, treatment should be planned according to the time and size of the troubles and problems you experience. Of course, immediate revision is not recommended for every patient with problems. First of all, the underlying causes of this problem, anatomical, functional and, of course, the patient’s factors should be investigated and it should be checked whether there are any non-surgical corrections.

Especially after Gastric Bypass, we see that the biggest reason for weight gain is that patients cannot quit their sugar eating habits. The reason for this is that Dumping Syndrome is usually overcome. Pouch deformations are a common occurrence when these patients are examined. Eating modifications do not work very well in such patients. Considering surgical correction in the foreground becomes essential for permanent control of the problem. In these patients, we usually apply a revision process to the Duodenal Switch.

Who is revision surgery performed by and where?

Revision surgery operations are highly specialized and require serious experience and skill. The physician and unit who will perform the procedure should preferably have all of the following features.

Lots of laparoscopic surgery experience (At least 2000 laparoscopic surgeries, at least 1000 bariatric surgeries)

To be able to perform all kinds of bariatric surgery operations

Being able to perform endoscopic evaluation and procedure and having a fully equipped endoscopy unit

Performing the procedure in a fully equipped hospital where all relevant branches and intensive care can be provided.

Do diseases such as diabetes, asthma, blood pressure prevent revision surgery?

On the contrary, these are diseases caused and exacerbated by obesity. These diseases are not an obstacle for surgery but a reason.

How to prepare before revision surgery?

First of all, detailed information about the previous surgery of the patient should be obtained. First, there should be an epicrisis of surgery and diseases. Endoscopy should preferably be done by the physician who will perform the operation. In addition to endoscopy, barium radiographs, medicated abdominal tomography or medicated magnetic resonance imaging methods may also be required in these patients to better understand the anatomical changes due to previous surgery.

Tomography, except for this, the following tests and examinations are applied to each patient before the surgery as if they were being operated for the first time; Blood Biochemistry tests Hemogram Hormone tests Hepatitis tests Whole abdominal ultrasound Stomach endoscopy (with anesthesiologist) ECG (Heart X-ray) Chest X-ray Pulmonary respiration test Effort test and ECO (Electrocardiography) After all these tests Anesthesia, Internal Medicine, Cardiology, Chest diseases and necessary examinations and examinations are made by endocrine specialists.

As a result of these examinations, it is first checked whether there is any underlying disease that may cause the patient to gain weight. If there is no such disease, the patient is examined in terms of anesthesia, like any patient who will undergo surgery, and it is checked whether there is an obstacle to the operation. Relevant specialists make recommendations about pre-operative treatments, if necessary. In this way, problems that may occur during and after surgery are minimized.

How is revision surgery performed?

Some procedures can be done by endoscopy without surgery. All procedures other than that, regardless of the method, are performed by laparoscopic (closed) surgery method. Here, the experience of the physician performing the procedure becomes much more important.

Laparoscopic surgery is performed by making many small incisions. The ports placed through these incisions are used for hand tools to reach the abdomen. One of them is a surgical telescope connected to a video camera and the others are for the introduction of specialized surgical instruments. The surgeon watches the operation on a video monitor.

With experience, an experienced laparoscopic surgeon can perform many procedures laparoscopically, just as in open surgery.

What can be done as revision surgery, what are the different applications?

Patients with Gastric Band: In these patients, the band is first removed. This process can be in one session or different sessions. In some patients, the band enters into the stomach, in these patients it may be necessary to remove the band endoscopically. After the band is removed, all kinds of surgical procedures can be applied to the patient as if there was no surgery.

In the patient with gastric bypass; If the passage between the stomach and intestine is enlarged, the passage can be narrowed with endoscopy and sclerotherapy in three or four sessions. In this way, the patient feels satiety for a longer time, as the food stays in the stomach longer. The intestinal loop joined to the stomach can be separated and rejoined later. In this way, the amount of calories taken is reduced as less of the intestines come into contact with the food. Bypassing the intestines, the relationship between the intestines and food can be limited.

In patients with slevee gastrectomy (tube stomach): First of all, if the first surgery is not sufficient or if the stomach is enlarged again, slevee can be performed again. Roux-en-Y (proximal) can be applied. This variant is the most commonly used gastric bypass technique and is the most commonly used bariatric procedure in the USA. It is the operation that causes the least nutritional problem. A proximal gastric (at the entrance of the stomach) stomach pouch smaller than 30 mL is created at the entrance of the stomach. This new gastric pouch has a smaller volume than about 1 tea glass.

By creating a stomach pouch, the existing stomach is deactivated and the food is brought here. It is taken from the part of the small intestines that goes towards the distal (large intestine) and cut approximately 50-75 cm and is connected to the newly formed stomach pouch. The end of the small intestine, which is left behind with bile and pancreatic fluid, is connected to the intestine approaching 70-80 cm.

Duodenal switch; In this process, the duodenum is separated and a connection is made from the part of the small intestine that goes towards the distal (large intestine). In this way, foods come into contact with less intestinal surface.

Transit Bipartition; This process helps to improve diabetes, especially in those with diabetes. A mouth is made from the part of the small intestine that goes towards the distal (large intestine), close to the stomach outlet. In this way, half of the food goes directly to the end of the gut, while half of the food travels the entire gut.

This not only reduces weight gain, but also saves the patient from insulin use by controlling sugar.

Gastric Bypass, Roux-en-Y (distal): Normal small intestine is between 600-1000 cm. The end of the intestine coming from the bile is connected with the intestine from which food comes about 1 meter further.

The combination of saffron with food towards the end of the small intestine mainly causes malabsorption (reduced absorption) of fat and starches, but also of various minerals and fat-soluble vitamins. Fats and starch that are not absorbed pass into the thick intestine.

This can provide faster weight loss. However, more serious problems with nutrition (such as severe vitamin deficiency) can be seen. In addition, bacterial activity here may cause the production of irritant substances and the formation of malodorous gas.

Is leakage test done in revision surgery?

A leakage test is performed during revision surgery and on the 2nd day afterwards. The purpose of the leak test performed in surgery is to determine whether there is a problem with the staples and whether there is a leak in the suture line. If there is a leak, additional stitches are placed on the relevant part to prevent leakage. Again, before starting liquid foods after surgery, a leak test is performed and necessary precautions are taken and intervened in time.

Are there stitches in revision surgery?

It is controversial to place additional stitches on special materials called staples in obesity surgeries. Some surgeons think that suturing reduces the possibility of bleeding and leakage and that every patient should be sutured. Some surgeons say that although suturing reduces the possibility of bleeding a little, it does not reduce the risk of leakage, on the contrary, it may cause more leakage and bleeding after vascular injury while suturing. As a clinical approach, we are between these two. Although we do not put additional stitches in every patient, if the stapler line is not safe enough for us, we definitely put additional stitches.

The fact that our results are much better than the world averages reveals that our method is more successful. The most important point here is that the surgeon performing the operation should have the ability and experience to intervene and correct all kinds of problems.

Why is blood thinner used in revision surgery?

During each surgery, there is a possibility that there is a blood clot in the vein and any vein occlusion. This can lead to serious problems when it’s a vessel that feeds vital organs such as the heart, lungs, and brain. As the weight of the patients increases, the risk of embolism increases. For this purpose, these patients are given blood thinners regardless of the surgery. Although it increases the risk of bleeding slightly, the benefit is much higher. The use of blood thinners starts before surgery and continues for another two weeks. The duration of use may be prolonged in patients with high risk, such as patients with cardiovascular disease or previous embolism.

Will there be pain after revision surgery? Will there be any scars after revision surgery?

Since revision surgery is performed laparoscopically (closed), that is, by entering through millimetric holes, post-intervention pain is less than open surgery. Nevertheless, the phrase “He was operated, of course he will have pain” is extremely wrong. No patient should experience pain in the twenty-first century. Pain relief is completely prevented by applying postoperative painkillers to each patient. The important point here is this. Everyone’s pain threshold is different. Again, drug tolerance and bioavailability from the drug are different. Therefore, treatment cannot be standard. Pain relief treatment should be arranged individually according to the needs of each patient.

Since the incisions are very small, the aesthetic results are also extremely good. After a few months, these lines will also become almost invisible. Once the wounds have healed, you will be recommended a cream to leave less scarring. If you use it for three months, you will get much better aesthetic results.

When will nutrition begin after revision surgery?

On the second day of the surgery, you will start taking liquid food after the leak test is done. After the first two weeks of liquid nutrition, you will be fed with soft (puree style) food for two weeks. During this whole process, you will be in constant communication with our dieticians.

How will nutrition, vitamin and mineral supplements be done after revision surgery?

Protein supplements are given to patients during the first 15 days. Various vitamin and mineral supplements are given to patients especially in the first year. Protein vitamin usage times vary according to the type of surgery performed. These are not standard for every patient, and after the examinations performed in routine controls, they are decided according to what the patient needs and how much.

Can the patient stand up immediately after revision surgery, can the patient return to work immediately?

The surgery is laparoscopic (you can get up and walk within an hour or two after the surgery because it is performed closed. ) You will not be a nursing patient even during your hospital stay, you will be able to do your own self-care.

Patients working on a desk or in jobs that do not require heavy effort can return to work within a week. Patients who require heavy effort should take a break from work for at least a month. After the operation, patients are given a sufficient resting report.

When are stitches removed after revision surgery?

Since self-absorbing stitches are used frequently, there is no need for stitches. If non-absorbable stitches are used for a different reason, the stitch will be checked and taken if appropriate when you come to the control on the 7th day.

When can one take a bath after revision surgery?

You can take a bath when you leave the hospital. There is no problem if the seams are open and wet. After showering, dry it with a clean towel, apply baticon on them and wait for it to dry. Baticon does not stain your clothes permanently. There is no need to use baticon after the tenth day.

Can the patient use medication after revision surgery?

Do not use any medication other than the ones we recommend for the first month. When a medication is recommended by another physician, you should definitely consult us. You can use any kind of medication after the first month. Still, try not to use too much painkillers and drink plenty of fluids after taking medication.

How does revision surgery work?

Although the mechanism is different according to the method applied, it is basically to reduce the food intake provided and to ensure that the food taken is less in contact with the intestines. In addition, the hormonal mechanism that changes between the stomach and intestines provides both the control of sugar level and faster weight loss.

 There be weight gain again after revision surgery?

The risk of regaining weight after revision surgery is very low. In order to get maximum benefit from this physiology, the patient should only eat at meals, take 2-3 meals a day, and avoid snacks between meals. This surgery also requires changing the eating habits acquired over a long period of time. In almost all cases where weight gain was observed again in the late stages of the surgery, there was no increase in meal capacity.

The reason for regaining weight is especially high-calorie snacks between meals. There is no known operation to eliminate the side effects of this type of eating. Safety is important, not cost, in health.

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