Revision Operations

Revision operations are surgical procedures performed to correct the results of previously performed surgical procedures. People sometimes undergo surgery for medical necessity or cosmetic concerns. However, the results of these surgeries are not always as desired. Revision operations are therefore performed to correct these results.

Revision operations are not only used for specific surgeries, but also for all types of surgical procedures. Therefore, this concept can be used for many surgeries.

What is Revision Surgery?

Bariatric surgical methods applied for the treatment of obesity are quite effective. Methods such as gastric bypass, gastric banding, and sleeve gastrectomy are used to help patients lose weight. Thus, disease risks associated with weight are eliminated, and the patient’s quality of life is improved.

After surgical procedures for obesity treatment, it is expected that patients will lose weight and not regain the weight lost. However, in some patients, weight loss does not occur to the desired extent, or the lost weight is regained quickly. In such cases, the option of undergoing surgery again comes up, which is called revision surgery or revision operations.

When any surgery fails to achieve the desired result due to patient-related or technical problems, a second surgery is performed, called a revision operation. These operations usually come up after bariatric surgical procedures.

Gastric banding surgery is the most commonly revised surgical procedure. If complications occur or the desired effect is not achieved, the gastric band is usually removed, and a different method is used.

The goal of revision operations is to improve the results of the previous surgical procedure or correct factors that prevented the desired effect from occurring. Depending on the person’s condition, the number of revision surgeries may vary. However, generally, existing results can be corrected with one revision surgery.

Why Are Revision Operations Performed?

The reason for performing revision operations is to correct unwanted results or improve the results. The success rate of surgeries performed for obesity patients is around 90%. In other words, the results are not as desired in the 10% section.

After bariatric surgery, patients are expected to lose weight permanently. Within 18 months, patients are expected to lose approximately 50% of their current weight. If the weight loss during this period is far from this figure, the surgery is considered unsuccessful, and revision operations come into play.

In general, the reasons for these operations are as follows:

• Complications from previous surgery
• Inability to lose weight at the desired level
• Non-permanent weight loss
• Malnutrition and its associated risks

In the operations carried out for revision, it may be possible to focus on improving the current situation or to use different methods. This decision is taken by the surgeon who will perform the procedure, taking into account the patient’s condition.

To Whom Revision Operations Are Performed?

When undesirable results occur after bariatric surgery, revision surgery comes to the fore. Results can be improved with revision surgery, but these additional operations cannot be applied to every patient. The following patients are not suitable for revision operations:

• Addictive substance users
• Those with eating disorders
• Those who do not accept medical treatment despite having reflux and ulcer complaints
• Those whose general health status is not suitable for revision surgery
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• Those who do not meet the requirements for anesthesia

Even if the results of the previous bariatric surgery are not as desired, revision surgery is not applied to these people. Because in the current situation, performing an additional surgery involves a great risk for the patients of this type.

How are Revision Operations Performed?

Firstly, the patient’s condition must be evaluated for revision surgery or revision operation. During this process, it should be determined whether the patient caused the surgery to fail or whether the operation did not provide the desired results in this patient. For this, both the surgical procedure performed and the patient’s lifestyle and nutrition should be examined. Therefore, this process is quite difficult and sensitive. Proper management of this process will ensure that the most appropriate method is found for the patient.

In the evaluation process, not only the surgeon but also the endocrinology department, psychologist, and dietitian are involved. The patient’s psychology and nutrition can affect the results of bariatric surgery. Therefore, the evaluations of the dietitian and psychologist are also very important. The medical reasons for the failure of the surgery are investigated. For this, methods such as blood tests, respiratory function evaluations, and endoscopy can be used. The decision for revision surgery is made depending on the data obtained and the general condition of the patient. A new surgical procedure is performed according to the decision taken.

Risks and Complications of Revision Operations

Revision operations have significant advantages such as improving results and eliminating complications. However, it should not be forgotten that these surgical procedures also have their own risks and side effects. Moreover, these risks are higher than the first surgery. For example; the risk of internal bleeding in a patient undergoing obesity surgery for the first time is 1%, while in revision operations, this rate can go up to 4%. The risks and side effects vary depending on the size of the revision operation and the procedure performed. However, generally, risks and side effects can be expressed as follows:

• Bleeding
• Infection
• Embolism
• Intra-abdominal adhesion
• Internal bleeding
• Cosmetic issues
• Bruising
• Pain
• Swelling

Although the risks of revision operations are higher than the first operation, the healing process is almost similar. Patients can gradually return to their daily lives after spending the first week resting. In the first days, bruising and swelling occur in the related area. There may also be some pain. However, these disappear on their own over time.

Revision Operation Implementation Methods

If the first obesity surgery is chosen incorrectly or is insufficient, revision operations come to the fore. If the right method is chosen in these operations, the success can even exceed 90%. Therefore, each patient should be evaluated individually. The type of the first operation, its results and the behavior of the patient after the operation should be taken into account.
After the evaluation, a different method can be used in the revision operation, and the errors in the first operation can be corrected. The revision methods applied according to obesity surgeries are as follows:

• Gastric Bypass
  Gastic bypass surgery involves reducing the stomach and shortening the passage between the stomach and the intestine. If it is determined that the passage between the stomach and intestines is widened after the operation, a revision operation decision is made. In the operation, the widened passage is restored, thus allowing patients to feel full for a longer period of time.
• Gastric Band
  If the desired success cannot be achieved from the gastric band operation, the gastric band is removed and a different obesity surgery is performed depending on the patient’s condition.
• Tube Stomach Surgery
  Gastric sleeve surgery allows the stomach to be reduced by 85%. However, after the patient does not comply with the diet, there is a risk of stomach enlargement and weight gain. The revision operation to be applied to patients in such a situation is performed in such a way that the stomach is significantly disabled and the food is transferred directly to the small intestine. However, each patient is evaluated individually and appropriate methods are applied.
  Although obesity surgeries come to mind first when revision operations are mentioned, revision operations can also be performed after different surgeries such as rhinoplasty. Aesthetic surgeons improve previous results with related operations.