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May 19, 2023

Revisional Bariatric Surgery in Turkey!

Table of Contents

What is the Revisional Bariatric Surgery?

Revisional bariatric surgery, also known as secondary or reoperative bariatric surgery, is a procedure performed on individuals who have previously undergone bariatric surgery but require further surgical intervention due to inadequate weight loss, weight regain, or complications from the initial surgery. The goal of revisional surgery is to address these issues and improve the patient's weight loss outcomes.

What are the Methods of Revisional Bariatric Surgery?

There are several methods or techniques used in revisional bariatric surgery, depending on the specific circumstances and needs of the patient. Here are some common methods:

  1. Conversion to a Different Procedure: In some cases, the revisional surgery involves converting the original bariatric procedure to a different one. For example, a patient who had a gastric band may undergo a conversion to a gastric bypass or sleeve gastrectomy. This is often done when the initial procedure has not yielded satisfactory results or has led to complications.
  2. Stomach Pouch or Stoma Reduction: In procedures such as gastric bypass or sleeve gastrectomy, the size of the stomach pouch or the stoma (the opening between the stomach and small intestine) can be enlarged over time, leading to reduced weight loss or weight regain. Revisional surgery can involve reducing the size of the pouch or stoma to restrict food intake and promote weight loss.
  3. Gastric Band Adjustment or Removal: For patients who have undergone gastric banding surgery, revisional procedures may involve adjusting the band or removing it altogether. If the band has caused complications or is no longer effective, it may be replaced with another bariatric procedure.
  4. Bile Diversion or Duodenal Switch Revision: In cases where patients have undergone a bile diversion or duodenal switch procedure, revisional surgery may be performed to adjust or optimize the anatomy of the procedure. This can involve modifying the length of the common channel or bile limb to improve weight loss outcomes.
  5. Endoscopic Revisional Procedures: In some cases, revisional procedures can be performed endoscopically, meaning they are done through the mouth without making any incisions. These procedures may involve using endoscopic tools to reduce the size of the stomach pouch or stoma, or to place sutures or devices to restrict the passage of food. Istanbul Bariatric Center is one of the unique centers that provide Apollo Revise endoscopic revisional procedures in Turkey.

What are the Reasons of Weight Regain After Weightloss Surgery?

Weight regain after bariatric surgery can occur for several reasons. Here are some common factors that can contribute to weight regain:

  1. Inadequate Lifestyle Changes: Bariatric surgery is most effective when combined with significant lifestyle changes, including adopting a healthy diet and incorporating regular exercise. If a patient fails to make sustainable changes to their eating habits or physical activity levels, weight regain can occur.
  2. Poor Dietary Choices: Over time, some individuals may revert to their pre-surgery eating patterns, consuming high-calorie, low-nutrient foods. This can stretch the stomach pouch or stoma, leading to increased food intake and reduced weight loss.
  3. Snacking and Grazing: Constant snacking or grazing throughout the day can contribute to weight regain. These habits can undermine the restrictive nature of the surgery and lead to consuming more calories than intended.
  4. Psychological and Emotional Factors: Bariatric surgery does not address underlying psychological or emotional issues related to food. If emotional eating, stress, or other psychological factors are not adequately addressed, they can contribute to weight regain.
  5. Hormonal Changes: Hormonal changes, such as the return of hunger and satiety hormones to pre-surgery levels, can impact appetite and weight regulation. These changes may affect the ability to maintain weight loss in the long term.
  6. Surgical Complications or Anatomical Changes: Certain surgical complications, such as the enlargement of the stomach pouch or stoma, can reduce the restrictive effect of the surgery, allowing larger food portions to be consumed. Additionally, anatomical changes over time, like the dilation of the pouch or stoma, can contribute to weight regain.
  7. Medications and Health Conditions: Certain medications or health conditions, such as hypothyroidism or polycystic ovary syndrome (PCOS), can affect weight management. If these factors are not effectively managed, they can contribute to weight regain.

It's important to note that weight regain is not uncommon after bariatric surgery, and it does not mean the surgery has failed. However, it is essential for individuals who experience weight regain to consult with their healthcare team, including a bariatric surgeon and registered dietitian, to identify the underlying causes and develop a plan to address them. This may involve lifestyle modifications, behavioral counseling, dietary adjustments, or revisional surgery in some cases.

Bariatric Surgery Team
Revisional Bariatric Surgery

What are the Options for Revision After Gastric Band Surgery?

After gastric band surgery, if a patient experiences complications or inadequate weight loss, revisional surgery may be considered. Here are some options for revision after gastric band surgery:

  1. Conversion to Sleeve Gastrectomy: Sleeve gastrectomy involves removing a portion of the stomach to create a smaller, banana-shaped stomach pouch. It is a popular revisional option after gastric band surgery. The procedure removes the band and transforms the surgical anatomy to promote weight loss.
  2. Conversion to Gastric Bypass: Gastric bypass surgery involves creating a small stomach pouch and rerouting a portion of the small intestine. This revisional procedure is often performed if there are complications with the gastric band or if the patient has not achieved desired weight loss. Gastric bypass can provide more significant weight loss and metabolic benefits.
  3. Removal of the Gastric Band: If a patient experiences complications or no longer wishes to have the gastric band, a simple removal surgery may be performed. This option is considered if there are issues such as band erosion, infection, or intolerance to the band.
  4. Adjustable Gastric Band Replacements: In some cases, a revisional surgery involves replacing the existing gastric band with a new adjustable band. This may be done if the original band has caused complications or is no longer effective, and the patient desires to continue with a restrictive procedure.
  5. Revision with a Different Bariatric Procedure: Depending on the patient's specific circumstances, a revisional surgery after gastric banding may involve a different bariatric procedure altogether. Options such as duodenal switch or biliopancreatic diversion may be considered if there are significant weight loss challenges or metabolic concerns.

What are the Options for Revision After Gastric Sleeve Surgery?

After a sleeve gastrectomy operation, if a patient experiences complications or inadequate weight loss, revisional surgery may be considered. Here are some options for revision after sleeve gastrectomy:

  1. Conversion to Gastric Bypass: Gastric bypass surgery involves creating a small stomach pouch and rerouting a portion of the small intestine. It is a common revisional procedure after sleeve gastrectomy. Conversion to gastric bypass can provide additional restriction and malabsorption, leading to improved weight loss outcomes.
  2. Conversion to Duodenal Switch: Duodenal switch surgery combines sleeve gastrectomy with a significant intestinal bypass. It involves creating a smaller stomach pouch and rerouting a larger portion of the small intestine. This revisional option is considered for patients with inadequate weight loss or significant weight regain after sleeve gastrectomy.
  3. Stomach Pouch or Stoma Resizing: In some cases, if the stomach pouch or the stoma (the opening between the stomach and small intestine) has stretched over time, revisional surgery may involve resizing these structures to restore the restrictive effect. This can be done by reducing the size of the stomach pouch or narrowing the stoma.
  4. Addition of a Gastric Band or Minimizer Ring: In certain cases, a gastric band may be added to the sleeve gastrectomy to enhance restriction and weight loss. This is known as a sleeve gastrectomy with gastric banding revision. The band can provide adjustable restriction and may be helpful for patients who have not achieved desired weight loss or are experiencing weight regain.
  5. Endoscopic Revisional Procedures: Endoscopic procedures offer less invasive options for revision after sleeve gastrectomy. They involve using an endoscope to access the stomach and make adjustments without the need for open surgery. Endoscopic techniques such as endoscopic suturing, endoscopic sleeve gastroplasty, or endoscopic stoma resizing can be considered for weight regain or inadequate weight loss after sleeve gastrectomy. Istanbul Bariatric Center is one of the unique centers that provide Apollo Revise endoscopic revisional procedures in Turkey.

The choice of revisional surgery after sleeve gastrectomy depends on various factors, including the patient's weight, overall health, previous surgical complications, and weight loss goals. It is important to consult with a bariatric surgeon who specializes in revisional procedures to determine the most suitable option for each individual case. The surgeon will evaluate the specific circumstances and recommend the appropriate revisional strategy.

Revisional Bariatric Surgery

What are the Options for Revision After Gastric Bypass Surgery?

After gastric bypass surgery, if a patient experiences complications or inadequate weight loss, revisional surgery may be considered. Here are some options for revision after a gastric bypass operation:

  1. Conversion to a Distal Gastric Bypass: Distal gastric bypass, also known as mini-gastric bypass or single-anastomosis gastric bypass, is a revisional procedure that involves modifying the anatomy of the initial gastric bypass. It involves creating a new connection between the stomach and the small intestine, bypassing a portion of the previous gastric bypass. This option may be considered for inadequate weight loss or weight regain after the initial gastric bypass.
  2. Conversion to Biliopancreatic Diversion (BPD) or Duodenal Switch (DS): BPD or DS procedures involve a more extensive modification of the anatomy compared to gastric bypass. These revisional surgeries reroute a significant portion of the small intestine, creating a malabsorptive component in addition to the restrictive aspect. They are considered for patients who experience significant weight regain or inadequate weight loss after gastric bypass.
  3. Stoma Resizing or Reversal: In some cases, revisional surgery after gastric bypass involves resizing or reversing the stoma, which is the connection between the stomach pouch and the small intestine. This can be done to address complications or improve weight loss outcomes. The stoma can be narrowed to enhance restriction or widened to improve tolerance and alleviate complications such as dumping syndrome.
  4. Pouch Resizing: If the stomach pouch created during the initial gastric bypass surgery has stretched over time, revisional surgery may involve resizing the pouch to restore restriction. This can be done by reducing the size of the pouch to limit food intake and promote weight loss.
  5. Endoscopic Revisional Procedures: Endoscopic approaches can be used for revision after gastric bypass without the need for open surgery. Endoscopic procedures such as endoscopic suturing, endoscopic stoma resizing, or endoscopic balloon placement can be considered for weight regain or inadequate weight loss. These procedures involve using an endoscope to access the stomach and make adjustments. Istanbul Bariatric Center is one of the unique centers that provide Apollo Revise endoscopic revisional procedures in Turkey.

What are the Options for Revision After Banded Vertical Gastroplasty Surgery?

Banded vertical gastroplasty, also known as stomach stapling or Mason procedure, is a bariatric surgery that involves creating a small stomach pouch and placing a band around it to restrict food intake. If a patient experiences complications or inadequate weight loss after a banded vertical gastroplasty, revisional surgery may be considered. Here are some options for revision after a banded vertical gastroplasty:

  1. Removal of the Band: If the band has caused complications or is no longer effective, a revisional surgery may involve removing the band altogether. This can be done to address issues such as band erosion, infection, or intolerance.
  2. Conversion to a Gastric Bypass: Conversion to a gastric bypass procedure may be considered if there are complications with the band or if the patient has not achieved desired weight loss. Gastric bypass surgery involves creating a small stomach pouch and rerouting a portion of the small intestine, providing more substantial weight loss and metabolic benefits.
  3. Conversion to a Sleeve Gastrectomy: Sleeve gastrectomy involves removing a portion of the stomach to create a smaller, banana-shaped stomach pouch. This revisional option after a banded vertical gastroplasty removes the band and transforms the surgical anatomy, promoting weight loss.
  4. Stomach Pouch or Stoma Resizing: If the stomach pouch or the stoma (the opening between the stomach and small intestine) has stretched over time, revisional surgery may involve resizing these structures to restore restriction. This can be done by reducing the size of the stomach pouch or narrowing the stoma to limit food intake and promote weight loss.
  5. Endoscopic Revisional Procedures: Endoscopic procedures can offer less invasive options for revision after banded vertical gastroplasty. They involve using an endoscope to access the stomach and make adjustments without the need for open surgery. Endoscopic techniques such as endoscopic suturing, endoscopic sleeve gastroplasty, or endoscopic stoma resizing can be considered for weight regain or inadequate weight loss.

What is the Success Rate in Revisional Bariatric Surgery?

The success rates and possible complications after revisional weight loss surgery can vary depending on several factors, including the type of revisional procedure, the patient's overall health, and individual circumstances. Here are some general considerations:

Success Rates:

  • Success rates for revisional weight loss surgery vary widely, as they depend on the specific goals and expectations of the patient. Generally, revisional procedures have lower success rates compared to primary bariatric surgeries.
  • Success can be measured by various factors, including weight loss, resolution or improvement of obesity-related health conditions, and overall improvement in quality of life.
  • The success of revisional surgery is often influenced by the reasons for the revision, the patient's commitment to lifestyle changes, and their ability to address underlying factors that contributed to the need for revision.

Possible Complications:

  • Revisional weight loss surgery carries risks similar to those of primary bariatric procedures, including complications related to anesthesia, bleeding, infection, and blood clots.
  • Specific complications associated with revisional surgery depend on the procedure performed. For example, conversion to a different bariatric procedure may introduce risks associated with the new procedure, such as malabsorption or nutrient deficiencies.
  • Complications related to scar tissue, adhesions, and altered anatomy from previous surgeries can increase the complexity of revisional procedures and pose additional risks.
  • Potential complications specific to revisional surgery may include leak or strictures at surgical connections, infection, bowel obstruction, or the need for additional surgeries due to persistent or recurrent issues.

It's crucial for individuals considering revisional weight loss surgery to have a thorough discussion with a bariatric surgeon who specializes in revisional procedures. We can provide a comprehensive evaluation of the potential risks and benefits based on the patient's specific circumstances. The success of revisional surgery can be optimized by selecting the appropriate procedure, addressing underlying factors, and committing to necessary lifestyle changes.

Murat Ustun

Is Surgeon's Experience Important in Revisional Bariatric Surgery?

The selection of a skilled and experienced surgeon is crucial for the success of revisional bariatric surgery. Here's why surgeon selection and experience are important:

  1. Complex Surgical Expertise: Revisional bariatric surgery is often more complex than primary procedures due to altered anatomy, scar tissue, and potential complications from previous surgeries. A surgeon with extensive experience in revisional procedures will possess the necessary skills and expertise to navigate these complexities and perform the surgery safely and effectively.
  2. Knowledge of Various Revisional Techniques: There are multiple options for revisional bariatric surgery, and the choice of procedure depends on the patient's specific circumstances. An experienced surgeon will have in-depth knowledge of different revisional techniques, allowing them to select the most appropriate option tailored to the patient's needs, previous surgery, and desired outcomes.
  3. Evaluation and Individualized Treatment: Revisional surgery requires a thorough evaluation of the patient's medical history, previous surgical records, and specific challenges they may have encountered. A skilled surgeon will conduct a comprehensive assessment to understand the underlying causes of the weight regain or complications and develop an individualized treatment plan that addresses those factors.
  4. Management of Surgical Complications: Revisional surgery carries a higher risk of complications due to the altered anatomy and scar tissue from previous surgeries. An experienced surgeon is better equipped to manage potential complications, promptly recognize and address surgical issues, and minimize risks during the revisional procedure.
  5. Patient Counseling and Support: Revisional bariatric surgery often involves managing patient expectations, addressing concerns, and providing thorough counseling regarding the potential risks and benefits. An experienced surgeon will have the communication skills to guide patients through the decision-making process and provide ongoing support before, during, and after the revisional surgery.
  6. Long-Term Follow-up and Care: The success of revisional bariatric surgery extends beyond the operating room. Regular follow-up visits and ongoing support are crucial for achieving and maintaining successful outcomes. An experienced surgeon will prioritize long-term care, monitoring the patient's progress, addressing any challenges, and providing guidance for lifestyle modifications.

Overall, the experience and expertise of the surgeon play a vital role in the success of revisional bariatric surgery. It is essential for patients to choose a surgeon who has a proven track record of performing revisional procedures and has specialized training in the field of bariatric surgery. Consulting with a reputable bariatric center and seeking multiple opinions, if necessary, can help ensure that the chosen surgeon is well-qualified to perform the revisional procedure and optimize the chances of a successful outcome.

When selecting a surgeon for revisional bariatric surgery, it's important to consider factors such as:

  1. Experience and Expertise: Look for a surgeon who has extensive experience and expertise in performing revisional bariatric procedures. Consider their track record, the number of revisional surgeries they have performed, and their success rates. Ask for published videos to get an idea about experience.
  2. Specialization in Bariatric Surgery: Ensure that the surgeon specializes in bariatric surgery and has specific training and qualifications in this field. Bariatric surgery is a highly specialized area, and a surgeon with dedicated expertise will be better equipped to handle revisional procedures. If a surgeon's website claims he/she is expert all areas of general surgery, from haemorrhoids to breast cancer, avoid from these centers.
  3. Board Certification: Verify that the surgeon is board-certified in bariatric surgery or a related specialty. Board certification demonstrates that the surgeon has met certain standards of knowledge, skill, and experience in the field.
  4. Patient Reviews and Testimonials: Read reviews and testimonials from previous patients to get a sense of their experiences and satisfaction with the surgeon and the outcomes of their revisional surgeries. This can provide insights into the surgeon's reputation and patient care. Some surgeons operates facilitator's patients in a mass production systeme and has no followup data about success and complications. Also they can not share any patient experience with you. Be careful about these centers.
  5. Personal Consultation: Schedule a consultation with the surgeon to discuss your specific situation, ask questions, and assess their communication style, approach, and willingness to address your concerns. A good surgeon should listen attentively, provide clear explanations, and make you feel comfortable. If the surgeon even can not communicate with you in English or you can only access the facilitator-coordinators, avoid to proceed with these kind of centers. Please ask the mobile number of your surgeon and check if you can access him/her when you need.
  6. Referrals and Recommendations: Seek referrals or recommendations from trusted sources, such as your primary care physician, other healthcare professionals, or support groups for bariatric surgery patients. They may be able to provide insights or suggest reputable surgeons in the field.

Ultimately, the choice of surgeon is a personal decision that should be based on thorough research, careful consideration of individual needs and preferences, and consultation with qualified medical professionals. It's important to find a surgeon who inspires trust and confidence and with whom you feel comfortable entrusting your care.

Is Turkey Safe for Revisional Bariatric Surgery?

Turkey has emerged as a popular destination for medical tourism, including bariatric surgeries, and it offers several advantages for revisional bariatric surgeries. Some potential advantages include:

  1. Experienced Surgeons: Turkey is known for having highly skilled and experienced surgeons in the field of bariatric surgery. Many surgeons in Turkey have received their training and education from reputable international institutions and have extensive experience in performing revisional bariatric surgeries.
  2. Advanced Medical Facilities: Turkey has invested in modern medical infrastructure and facilities. Many hospitals and clinics in major cities like Istanbul, Ankara, and Izmir are equipped with state-of-the-art technology and follow international standards for patient care and safety.
  3. Cost-Effective Treatment: Compared to many other countries, the cost of revisional bariatric surgeries in Turkey can be significantly lower while maintaining high-quality standards. This affordability makes it an attractive option for individuals seeking revisional bariatric procedures.
  4. Short Waiting Times: In some countries, there may be long waiting times for revisional bariatric surgeries due to high demand or limited resources. In Turkey, the waiting times are often shorter, allowing patients to receive the necessary treatment more quickly.
  5. Comprehensive Medical Tourism Services: Turkey has developed a well-established medical tourism industry that caters to the needs of international patients. Many medical tourism companies and facilitators provide assistance with travel arrangements, accommodation, language interpretation, and coordination with healthcare providers.
  6. Cultural Attractions and Hospitality: Turkey offers a rich cultural heritage and a variety of attractions, including historical sites, stunning landscapes, and vibrant cities. Patients can combine their medical journey with the opportunity to explore the country and experience Turkish hospitality.

While these advantages make Turkey an appealing option for revisional bariatric surgeries, it is important for individuals to thoroughly research and choose a reputable hospital or clinic with experienced surgeons and a track record of success in performing revisional bariatric procedures. It is also crucial to consult with medical professionals and make an informed decision based on individual medical needs and circumstances. Please be reminded, UK Goverment warned British citizens about 22 deaths in 2019 in Turkey because of the low quality/cheap centers. Don't forget, your budget is absolutely important, but your life is priceless!

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