Revision Operations

Revision operations refer to surgical operations performed to correct the results of previous surgical procedures. People undergo surgery sometimes due to medical necessity and sometimes due to cosmetic concerns. However, the results of these surgeries are not always as desired. Revision operations are performed to correct these results.

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

What is Revision Surgery?

Bariatric surgical methods applied for obesity treatment are highly effective. Methods such as gastric bypass, gastric banding, and sleeve gastrectomy enable patients to lose weight, thus eliminating health risks associated with obesity and improving their quality of life.

After undergoing surgery for obesity treatment, patients are expected to lose weight and maintain their weight loss. However, in some cases, weight loss may not occur at the desired level or the weight lost may be regained quickly. In such cases, the option of undergoing surgery again is considered. Re-operating on patients is referred to as revision surgery or revision operations.

If the desired outcome of any surgery is not achieved due to patient-related or technical problems, a second surgery performed is referred to as revision surgery. These operations are typically performed after bariatric surgery procedures.

Gastric banding surgery is the surgical procedure that requires the most revision surgery. If complications arise or the desired effect is not achieved, the gastric band is typically removed, and a different method is used.

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

Why Are Revision Operations Performed?

The reason for performing revision operations is to correct the undesired result or to improve the result. 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 need to lose weight permanently. Within 18 months, patients are expected to lose approximately 50% of their current weight. If the weight lost in this process is far from the mentioned figure, the surgery is considered unsuccessful and revision operations are brought to the agenda.

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
• 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?

Evaluation of the patient’s condition is necessary for revision surgery or revision operation. During this process, it should be determined whether the patient caused the operation to fail or whether the operation did not achieve the desired results in this patient. 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 lead to finding the best method for the patient.

In the evaluation process, not only the surgeon but also the endocrinology department, psychologist, and dietician play a role. The patient’s psychology and nutrition can affect the results of bariatric surgery. Therefore, the evaluations of the dietician and psychologist are also very important. Medical reasons for the failure of the surgery are investigated. Blood tests, respiratory function assessments, and endoscopy can be used for this. Based on the data obtained and the patient’s overall condition, a decision is made for revision surgery. A new surgical procedure is performed in accordance with the decision taken.

Revision surgeries have important advantages, such as improving outcomes 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 those of the initial surgery. For example, while the risk of internal bleeding in a patient who has undergone obesity surgery for the first time is 1%, this rate can reach up to 4% in revision operations. Risks and side effects vary depending on the size of the revision operation and the procedure performed. However, in general, 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.