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  • Writer's pictureProf.Dr. Abdulkadir Bedirli

Hurriyet Newspaper

THE PROBLEM OF WEIGHT GAINING AFTER BARIATRIC SURGERY AND REVISIONAL SURGERY

For people with health problems brought on by overweight and obesity, bariatric surgery is the most effective long-term treatment approach for weight loss solution. However, a few years after bariatric surgery, the person may face the problem of regaining weight.


Both old and new, all bariatric surgeries are designed to change how a person processes food. While all of these procedures are designed to be permanent, in reality not all effects of surgery are permanent.

General Surgery Specialist Prof Dr Abdulkadir Bedirli explained the questions about revision operations after obesity.


Gastric Band Revision

After tape application, the need for revision is one of the simplest procedures in theory. This is because patients do not undergo displacement such as cutting in the stomach or bypassing the small intestines. After gastric band, a patient with weight regain has two options. The first of these is the renewal of the tape, but it is not preferred much nowadays. The other two methods are to remove the band and convert the surgery to sleeve gastrectomy or gastric bypass surgery.


Revision of Sleeve Gastrectomy

After sleeve gastrectomy, the need for revision arises for two reasons. The first of these reasons is that the stomach is not sufficiently reduced in the operation. The second reason is that the stomach has the capacity to expand over time. There are two options for a patient with weight regain after sleeve gastrectomy. The first option is to re-sleeve, and the other is to convert to another bariatric surgery such as gastric bypass or duodenal switch.


Revision of Gastric Bypass Surgery

After gastric bypass, large gastric pouch or pouch enlargement is the most difficult situation in terms of revision. The enlargement of the mouth opening between the pouch and the small intestine can be resolved with the help of endoscopic sclerotherapies. Lengthening the alimentary canal, which is left short, is also a procedure that can be applied for revision purposes. However, when we are faced with a serious weight gain, a revisional duodenal switch will be more appropriate.


Important Steps About the Revision of Bariatric surgeries.

Revisional bariatric surgery is more difficult than primary bariatric surgery. If there is technical inadequacy in the primary surgery, it is more appropriate to perform revision surgery by more experienced surgeons. A detailed epicrisis report is needed before revision surgery. It is important to reveal the existing anatomy after the bariatric surgery of the patient. For this, patients should be applied barium passage graphies, computed tomography and endoscopic procedures. The patient's eating behavior and habits should be reported, and detailed laboratory analyzes should be performed before the surgery.


Which Option Is Better?

To eliminate the patient's problem of regaining weight, there is no definitive approach to determining an ideal revisional surgery. The surgeon should consider both the anatomical condition of the first bariatric surgery applied to the patient and the results that the revisional surgery may bring to the patient. In bariatric surgeries, robotic surgery can provide revisional convenience. The 10 to 12 times zooming capacity of the three-dimensional camera used in robotic surgery, the high freedom of movement of robotic instruments in different axes, the reduction in the sense of depth in robotic surgery are the factors that can increase the success of revisional bariatric surgery.



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