What is Revision Surgery?
Revisional bariatric surgery offers three potential options to address issues with previous weight loss surgeries:
- Conversion – Procedures that bring a change in type and/or mechanism of action from the previous surgery. Failures on weight loss are the most frequent cause of conversion.
- Revision – Procedures that modify parts of a surgical procedure without altering the type of surgery. The most common indications are failures on weight loss and complications.
- Restoration – Procedures that restore normal anatomy. Complications are the most frequent cause of restoration.
How much does revision and/or conversion surgery affect?
It is continuously growing. According to data from the scientific literature, the overall revision rate of bariatric surgery varies from 5 to 56 percent according to the study considered.
When is a revision of a previous intervention possible or necessary?
There is always the possibility of “salvage” surgery, then re-intervention; in these cases, it is necessary for the surgeon, together with the multidisciplinary team-which includes the psychologist-to frame the patient, to try to understand why the first surgery failed.
There can be many reasons for this: because the patient has not moved enough; because he has not changed his eating habits; because he has not followed the directions given to him by his care team; because he has not learned to chew slowly properly; or because he has had the pocket of the sleeve or gastric bypass enlarged over time.
The reasons can really be many; each patient is a world unto himself in this respect as well.
There can be many reasons for this: because the patient has not moved enough; because he has not changed his eating habits; because he has not followed the directions given to him by his care team; because he has not learned to chew slowly properly; or because he has had the pocket of the sleeve or gastric bypass enlarged over time.
The reasons can really be many; each patient is a world unto himself in this respect as well.
Patient engagement is always critical to the success of bariatric surgery
The intervention cannot succeed if the patient does not come to the intervention itself. We ask the person in severe excess weight to get back on the tracks of proper living and give all the guidance to do so.
We talk about a Mediterranean diet that is composed, precisely, of these basic elements, which are almost never consumed by the patients with obesity that we see every day. The patient must be willing to return to a healthier diet. If he does not do this, the intervention – over time is doomed to fail.
Can the occurrence of any complications after the first surgery indicate revision surgery?
Yes, any complications are anindication for revision surgery. Such complications may be early, that is, occurring 1-3 months after surgery, or late when they appear after 3 months up to several years, in cases that are in any case rare. Surgical (mechanical) complications depend on the type of surgery performed and are often independent of the effectiveness of the procedure.
Non-surgical complications may be due to nutritional deficits or-as mentioned above-poor patient adherence to their post-surgical rehabilitation course.
Non-surgical complications may be due to nutritional deficits or-as mentioned above-poor patient adherence to their post-surgical rehabilitation course.
Can there be cases of patients resisting weight loss?
They are rare, but in some cases resistance to weight loss may occur even after surgery, either first or revisional.
Regarding complications after revision, what is good to know?
Revision procedures have a higher risk of complications than primary surgery so it should always be reiterated and advised that patients should only and exclusively go to highly specialized centers certified by the Italian Society of Obesity Surgery (SICOB).
