Sleeve gastrectomy is one of the most preferred methods of bariatric surgery. In this method, food intake is limited by reducing the stomach. However, in some cases, sleeve gastrectomy surgery does not provide the expected weight loss or patients may gain weight again in the future. Revision surgery comes into play in such cases and involves additional changes in the structure of the stomach or digestive system.
What is Sleeve Gastrectomy Revision Surgery?
Sleeve gastrectomy revision surgery is a second surgical procedure performed for patients who cannot achieve the expected weight loss or experience complications after sleeve gastrectomy surgery. This surgery is usually performed to solve problems such as stomach enlargement, gastric hernia, reflux disease or insufficient weight loss. Revision surgery can be performed by re-shrinking the sleeve gastrectomy, switching to another bariatric surgery (for example, gastric bypass) or other surgical interventions. This procedure is re-planned to achieve better results for the patient.
Why is sleeve gastrectomy revised?
Sleeve gastrectomy (sleeve gastrectomy) is an effective surgical method frequently used in the treatment of obesity patients. However, in some patients, revision (correction) surgery may be required if the expected results cannot be obtained after surgery or various complications develop. Such revisions are performed to solve the patient's health problems and to regain weight loss. Conditions requiring revision;
- Insufficient weight loss: If the stomach volume cannot be reduced sufficiently with surgery, if the patient's metabolism is slow, if the patient cannot adapt to the diet, the weight lost after surgery may not be sufficient.
- Regaining the weight lost with surgery: If the stomach volume, which was reduced with the surgery, is enlarged again and diet and lifestyle habits cannot be maintained, weight may be regained.
- Psychological or nutritional problems: Surgical results may not be sufficient due to emotional connection with food or other psychological problems.
- Development of complications:
- Stomach Enlargement or Strictures: Enlargement of the stomach or obstruction in the gastrointestinal passage may prevent the proper passage of nutrients.
- Gastric Leaks: Leakage at the junction of the stomach pouch or intestine.
- Reflux disease (GERD): After surgery, stomach acid escaping back into the oesophagus can lead to severe reflux.
- Gastric Hernia (Hiatal Hernia): The development of a stomach hernia may prevent the regular passage of meals.
In such cases, gastric sleeve surgery can be revised. Especially in patients with reflux problems, methods such as gastric bypass may be more effective in reducing reflux.
Who Can Revision Surgery Be Performed?
Sleeve gastrectomy revision surgery may not be suitable for every patient. In order for revision surgery to be applied, both physical and psychological conditions must be appropriate. Patients who are suitable for revision surgery;
- Experiencing insufficient weight loss,
- Gaining weight again,
- Developing medical complications such as reflux, obstruction, gastric hernia, gastric leakage,
- People who have additional health problems such as diabetes and hypertension due to obesity.
Patients with serious health problems, patients who are not suitable for general anaesthesia, patients who cannot or do not want to change their eating habits after surgery are not suitable for revision surgery.
Types of Revision Surgery
When the expected results of sleeve gastrectomy cannot be achieved, other types of obesity surgery can be performed as revision surgery. The type of new surgery is selected according to the patient's condition, weight loss goals and complications experienced. The aim of revision surgery is to solve the patient's health problems and to restart weight loss.
1- Conversion to Gastric Bypass
Gastric bypass is one of the most preferred revision methods after sleeve gastrectomy. In this procedure, the stomach volume is further reduced and food absorption is restricted by reorganising the intestines. It is suitable for patients with metabolic disorders such as diabetes and hypertension, problems such as reflux, and weight regain.
2- Gastric Sleeve Gastrectomy
This method is applied in cases where the stomach is enlarged after the first sleeve gastrectomy. The surgeon performs a second operation to make the stomach smaller again. It is a suitable surgery for patients whose stomach expands again but who do not experience other complications.
3- Mini Gastric Bypass
Mini gastric bypass is a revision method applied with a simpler surgical technique compared to other methods. Both the stomach is reduced in size and some of the intestines are deactivated. It is suitable for patients who have not had gastric bypass before. It is preferred both for those who want weight loss and to treat metabolic diseases.
4- Duodenal Switch (DS)
Duodenal switch is a type of revision used to treat obesity or metabolic disorders after sleeve gastrectomy. This method both shrinks the stomach and limits absorption by disabling a large part of the intestines. It is a revision type suitable for patients with advanced obesity and people with severe other metabolic problems.
