Some patients may require revisional bariatric surgery when the initial procedure fails to achieve the intended weight loss goals or when weight regain occurs over time. In such situations, revisional bariatric surgery becomes a crucial therapeutic option to realign the treatment path and enhance long-term outcomes. This procedure involves a second operation following a previous bariatric surgery. It is designed either to reinforce weight loss or to resolve complications from the first surgery, such as acid reflux, gastric pouch enlargement, or food intolerance.
The decision to proceed with this intervention relies on a thorough assessment that considers the patient’s overall health and the type of prior bariatric procedure. While revisional bariatric surgery can yield favorable results, it demands advanced surgical expertise. It should be performed in specialized centers due to its increased complexity and risk compared to primary bariatric surgery.
What is revisional bariatric surgery?
Revisional bariatric surgery refers to a second surgical intervention performed after an initial bariatric procedure, typically when the desired weight loss is not achieved, when weight regain occurs after initial success, or when medical complications arise, such as gastroesophageal reflux, gastric pouch enlargement, or intolerance to implanted devices. This type of surgery is generally more complex than the primary procedure.
Revisional bariatric surgery requires a comprehensive evaluation that includes assessing the type of previous surgery, evaluating the patient’s commitment to dietary and lifestyle changes, and conducting a detailed review of the patient’s overall health before making a clinical decision. Revisional bariatric surgery aims to enhance weight loss outcomes, manage obesity-related conditions, and address complications; however, it requires advanced surgical expertise and should be performed in specialized centers to ensure optimal results and minimize potential risks.
The difference between revisional bariatric surgery and the primary procedure
Revisional bariatric surgery differs markedly from the primary procedure in terms of complexity, goals, and risks. In primary surgery, the primary goal is to reduce the size of the stomach or alter the digestive tract to achieve significant and sustained weight loss. In revisional surgery, the goal is focused on correcting unsatisfactory results or addressing complications such as reflux, gastric dilatation, or implant failure.
Technically, revisional bariatric surgery is more difficult due to the presence of adhesions or changes in anatomy as a result of the first operation, which increases the likelihood of complications such as bleeding or leakage. The recovery period can also be more extended, requiring the patient to undergo close post-operative follow-up. Despite these challenges, revisional bariatric surgery offers a significant opportunity to achieve additional weight loss and improved health, provided it is performed in specialized centers with sufficient experience.
When is revisional bariatric surgery needed?
Some patients may face situations that necessitate considering revisional bariatric surgery as a treatment option to correct the results or address complications. The decision is determined after a careful evaluation by the specialized medical team, focusing on the most significant cases, including:
- Failure to lose enough weight: In some cases, the first procedure does not achieve the desired weight loss, which may be due to the stomach expanding over time or the ineffectiveness of the first procedure. This is where revisional bariatric surgery helps to improve the results and achieve greater weight loss.
- Weight regain after initial success: The patient may experience initial weight loss followed by regaining the weight years later. Revision surgery seeks to adjust the previous procedure or transform it into a more effective operation to sustain the results achieved.
- Medical complications: Some patients may experience severe gastroesophageal reflux, intestinal obstruction, or intolerance to the belt or balloon. In such cases, revisional bariatric surgery becomes a therapeutic necessity to alleviate symptoms and enhance quality of life.
- Changing health needs: Sometimes the type of surgery is reconsidered if obesity-related conditions, such as diabetes or high blood pressure, appear and do not improve as desired, as revision surgery may provide more effective options.
What are the options for revisional bariatric surgery?
Revisional bariatric surgery methods vary depending on the type of previous operation and the reasons for its failure or complications. Surgical and endoscopic options include several techniques aimed at optimizing weight loss and addressing obesity-related health issues.
Vertical sleeve gastrectomy (VSG) to Roux-en-Y gastric bypass
Roux-en-Y gastric bypass is one of the most common forms of revisional bariatric surgery. This procedure is often performed when sleeve gastrectomy fails to achieve adequate weight loss or when severe gastroesophageal reflux develops that does not respond to medical treatment. In this procedure, a portion of the stomach and small intestine is bypassed, reducing the amount of food consumed and affecting the absorption of nutrients. Gastric bypass is highly effective for weight loss and controlling comorbidities such as diabetes and hypertension, but requires a long-term commitment to dietary supplements and careful medical follow-up.
One-Anastomosis Gastric Bypass
One-Anastomosis Gastric Bypass is an increasingly popular option for bariatric reoperation, especially when sleeve gastrectomy or previous operations have failed. This procedure is characterized by a single connection between the stomach and intestines, making it technically more straightforward than the classic bypass. It reduces the amount of food consumed and minimizes absorption, contributing to additional weight loss and improved comorbidities. Despite its simplicity, it may be associated with risks such as bile reflux or vitamin and mineral deficiencies, requiring careful follow-up after the procedure.
Repair or modify a previous Roux-en-Y gastric bypass(RYGB)
In some cases, the initial bypass is not sufficient to achieve long-lasting results, necessitating the need for repeat bariatric surgery to modify or repair the previous operation. These procedures include minimizing the gastric pouch that may have expanded over time, repairing the connection between the stomach and intestine, or adjusting the length of the intestine to achieve a better balance between restriction and malabsorption. These procedures are typically reserved for patients who have regained weight years after bypass or have developed digestive issues. Although they are effective, they are technically complex and require an experienced surgeon.
Gastric Band Removal
The gastric band is one of the oldest treatment options for obesity. Still, it has declined significantly due to high failure rates and complications such as slippage, erosion, or poor weight loss. When these issues occur, revisional bariatric surgery is performed by removing the band and replacing it with another procedure, such as sleeve gastrectomy or gastric bypass. This procedure yields more effective long-term results, particularly in achieving and maintaining weight loss, as well as controlling comorbidities. However, belt removal requires caution due to the adhesions that may have formed around the stomach.
From balloon or endoscopic procedures (such as Endoscopic Sleeve Gastrectomy )
Gastric balloon and endoscopic procedures, such as endoscopic sleeve gastrectomy (ESG), are usually used as a temporary option or for patients with less severe obesity. However, this type of procedure may fail to achieve long-term weight loss or maintain results, necessitating a shift to more effective procedures through revisional bariatric surgery, such as sleeve or gastric bypass. These procedures offer patients the opportunity to achieve more stable and lasting results, but require a thorough evaluation to determine their readiness for major surgery.
Resorting to advanced procedures such as BPD/DS or SADI-S
In some complex cases or when extreme efficacy is needed in the treatment of obesity and type 2 diabetes, surgeons may resort to advanced operations such as the biliopancreatic diversion with duodenal switch (BPD/DS) or its simplified version (SADI-S). These operations combine significant food restriction with pronounced malabsorption, resulting in robust weight loss and significant improvement in metabolic disease. Although effective, they are considered one of the most complex types of revisional bariatric surgery, requiring strict adherence to dietary supplements and long-term follow-up to prevent malnutrition.
Expected benefits of revisional bariatric surgery
Revisional bariatric surgery may provide patients with a new opportunity to achieve better results, particularly when the initial operation did not meet the desired outcome. Key benefits include:
- Achieving additional weight loss: Revisional bariatric surgery helps reestablish effective weight reduction when the initial procedure fails or when weight regain occurs after a period of success.
- Improving obesity-related conditions: It can aid in managing chronic diseases such as type 2 diabetes, hypertension, and sleep apnea, especially when a more suitable surgical technique is selected.
- Correcting complications from the initial surgery: This includes addressing severe gastroesophageal reflux or removing poorly tolerated devices, such as the gastric band.
- Enhancing quality of life: Sustained weight loss and resolution of complications lead to improved physical activity, better health outcomes, and overall life satisfaction.
Success rate for revisional bariatric surgery
The success rate of revisional bariatric surgery varies based on the type of initial procedure, the underlying cause of failure or weight regain, and the specific revision technique selected. Research indicates that patients can achieve further weight loss and improvement in obesity-related conditions, although the outcomes are generally less pronounced than those seen after primary bariatric surgery. Success is closely tied to the patient’s commitment to following dietary guidelines, engaging in regular physical activity, and maintaining consistent medical follow-up after surgery. Overall, revisional bariatric surgery presents a viable opportunity to enhance outcomes in appropriately selected patients. Still, it is not a guaranteed fix—it requires thorough evaluation and careful patient selection to maximize its benefits.
Risks and challenges
Despite the benefits, revisional bariatric surgery is more complicated than the initial surgery and may carry higher risks, including
- High rate of surgical complications: Bleeding, infection, or gastric leakage as a result of fibrosis from the previous operation.
- Longer recovery time: Recovery from repeat bariatric surgery often takes longer than from the initial surgery.
- Possibility of limited weight loss: In certain cases, patients may not achieve the desired weight reduction even after undergoing a revision.
- Requirement for specialized expertise: Revisional bariatric surgery demands highly skilled surgeons and advanced medical centers due to its technical complexity.
Tips before considering revisional bariatric surgery
Before undergoing revisional bariatric surgery, it is advisable to do the following:
- Comprehensive medical evaluation: A careful review of the medical history, type of previous operation, and identification of the reasons for its failure.
- Psychological and behavioral follow-up: Psychological and behavioral support is necessary to avoid habits that may lead to weight regain.
- Choosing a specialized center: Revision surgery should be performed in hospitals with high expertise and advanced equipment.
- Commitment to lifestyle changes: Ensure that the patient follows a healthy diet and engages in regular physical activity, as failure to do so may jeopardize the outcome of any surgery.
After revisional bariatric surgery
The success of revisional bariatric surgery depends not only on the operation itself, but also on the patient’s adherence to post-procedure medical instructions. Some of the most important tips include:
- Follow a gradual diet: The patient begins with liquids and then progresses to soft foods before gradually reintroducing solid foods, as instructed by the medical team.
- Adherence to nutritional supplements: You may need to take supplements, such as vitamins and minerals, to compensate for deficiencies caused by changes in absorption after surgery.
- Regular medical follow-up: It is essential to attend regular check-ups to monitor weight loss and detect any potential complications early.
- Engage in regular physical activity: Introducing proper exercise helps to promote weight loss and maintain long-term results.
- Ongoing psychological and behavioral support: Help to adjust to a new lifestyle and avoid habits that may lead to weight regain.
Advantages of having revisional bariatric surgery in Turkey
Turkey is a prominent destination for revisional bariatric surgery for several reasons:
- Expertise of medical centers: These are hospitals that specialize in bariatric surgery, featuring surgeons with extensive experience in complex procedures.
- Modern technologies: Utilizing the latest endoscopic tools and advanced surgical techniques increases the accuracy and safety of the procedure.
- Competitive cost: Turkey offers a more affordable option compared to many European countries while maintaining a high level of quality.
- Accompanying services: This includes medical follow-up, comfortable accommodation, and supportive logistics services for international patients.
Revisional bariatric surgery is a valuable option for patients who did not achieve satisfactory results from their initial procedure or developed complications requiring further intervention. It enables additional weight loss, better management of obesity-related conditions, and correction of issues such as reflux, gastric enlargement, or device intolerance. However, it remains a technically demanding procedure with higher risks than primary surgery, necessitating expert surgical skills and specialized facilities to ensure optimal outcomes.
A detailed evaluation of both medical and behavioral factors is critical before proceeding, and long-term success depends on the patient’s commitment to lifestyle changes. With proper preparation and follow-up, revisional bariatric surgery can offer a renewed path to improved health and quality of life for those who did not fully benefit from their first operation.
Sources:
- Mirkin, K., Alli, V. V., & Rogers, A. M. (2021). Revisional bariatric surgery. Surgical Clinics of North America, 101(2), 213-222.
- Switzer, N. J., Karmali, S., Gill, R. S., & Sherman, V. (2016). Revisional bariatric surgery. Surgical Clinics of North America, 96(4), 827-842.
- Pereferrer, F. S. (2023). Revisional bariatric surgery: On stage! Cirugía Española (English Edition), 101(2), 77-79.
- Chen, S., Chiang, J., Ghanem, O., & Ferzli, G. (2024). Decision-making considerations in revisional bariatric surgery. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 34(4), 400-406.