The revision surgeries are performed by the English-speaking doctor, in Antalya, laparoscopically. 

Information on corrective surgery after a bariatric procedure

 

If you have already received an operation for weight loss, it may be that months or years after the operation there will be certain difficulties. This is quite rare and should be discussed in practice. At this point, we would like to provide you with some information in advance so that you can describe and discuss your problems in more detail for a medical consultation.

 

The following problem groups can be identified, regardless of which intervention was previously performed on you:

 

insufficient weight loss significant re-increase in body weight despite previous good weight loss.

 

Complaints caused by frequent vomiting very frequent heartburn, rising of gastric juice with coughing attacks, especially when lying down constrictions in the upper digestive tract with obstruction of passage Ulcer formation in the small stomach pouch Lack of weight loss or a significant increase in body weight after surgery are actually never caused by changes to the operated stomach. Most of the reasons are non-compliance with dietary recommendations, insufficient physical activity (swimming, walking the dog, climbing two stairs a day is not enough). Often, behavioral patterns that have led to overweight and obesity are maintained despite intensive counseling or resumed in frustration situations. These conditions require a new extensive clarification and usually also psychotherapy in order to work up and eliminate the wrong development.

 

Very rarely, anatomical reasons on the operated stomach or small intestine are the cause for the above-mentioned weight curves. For example, a defective gastric band can lead to an increase in weight, a fistula between the small stomach pouch and the stomach turned off, or a distended tube stomach over time.

 

In order to find out such causes, an X-ray examination and a gastroscopy are usually required in advance.

 

Typical complications of the individual surgical procedures will be presented below:

 

Gastric banding:

a maximum constricted gastric band leads to frequent vomiting several times a day. As a result, the stomach located below the gastric band can turn upwards through the gastric band and thus lead to a passage obstruction. This condition is called slippage. Complete emptying of the gastric band immediately eliminates discomfort. However, as a rule, slippage cannot be eliminated without surgery.

 

A highly constricted gastric band also leads to an expansion of the esophagus and often to a long-term retention of portions of food in the esophagus with corresponding inflammatory reactions. It can cause reflux of gastric juice and food residues into the trachea while lying down. As a result, coughing attacks occur.

In rare cases, the gastric band can also migrate through the stomach wall and then lie in the stomach, causing weight gain again (arrosion).

All these states require correction. This consists of removal of the gastric band. The removal of the gastric band alone leads to a re-increase in body weight in 99%. Therefore, it is worth considering combining the removal of the gastric band with another procedure (bypass, tubular stomach).

From large statistics it is known that the re-insertion of a gastric band does not have good results.

 

Tube stomachs:

About 30% of patients lose 60% of their excess weight after gastric sleeve surgery, as well as a substantial elimination of their concomitant diseases. About 10% of patients do not achieve this reduction in their weight, but lose so much weight that they are satisfied with the result, since most of the concomitant diseases have been eliminated or significantly improved. The rest experience only a minimal weight reduction and are not satisfied with the result.

 

The cause of insufficient weight reduction are:

 

No change in eating habits, insufficient physical activity and continued behavioral errors regarding food intake.

Rarely there are anatomical reasons for the lack of weight loss. In some cases, too little was removed from the stomach during the operation. In most cases, however, patients have taken too large amounts of food per serving in the long run and thus gradually caused an increasing dilation of the tubular stomach (dilatation). The gastric tube is a muscle that wears out with constant overstretching, thereby getting bigger again and also allowing larger portions.

Cicatricial narrowing in the gastric tube (stenosis), as a rule, leads to more frequent vomiting and heartburn. This condition, if it occurs early, can possibly be treated with an expansion. This is done without surgery with the gastric mirror over which a balloon is inserted for dilation. Another possibility, in the case of a narrowing that occurred at an early stage, is to insert a self-expanding stent (a tube widening the narrowing). This also happens with the level of the stomach. The stent is removed again after 4-6 weeks. If these measures do not bring about a permanent improvement, an operative correction must be made. The tubular stomach is then preferably converted into a bypass.

Many patients suffer from heartburn even before the operation. Heartburn is provoked by gastric juice flowing back into the esophagus. In many patients, these complaints improve when the body weight decreases. However, in some patients there is no improvement or even an increase in heartburn. In about 8% of patients who did not have heartburn before gastric sleeve surgery, these complaints are newly formed. For the most part, it is possible to improve or eliminate heartburn with acid-blocking drugs. However, when gastric juice, especially when lying down, passes through the esophagus to the larynx, coughing attacks occur, which can be very excruciating and cannot be eliminated by tablets. In this case, only a corrective operation remains, which, as a rule, also consists in the transformation of the tubular stomach into a bypass.

With insufficient weight loss and a greatly expanded tubular stomach, the re-reduction of the tubular stomach rarely leads to good results. This measure should then be combined with an additional bypass operation. That is, the tubular stomach is reduced in size, and in addition, in front of or behind the exit from the stomach, a partial shutdown of the small intestine is made.

 

Gastric bypass:

For gastric bypass with regard to insufficient weight loss or renewed weight gain, the same explanations apply as just indicated for the tubular stomach. The small portion of the stomach (stomach bag, technical term: stomach pouch) can also expand in case of too large food portions and absorb more food again. However, it is more important that the connection between the stomach pouch and the subsequent small intestine also widens and thus the food can slip out of the pouch into the small intestine much faster. This condition is basically due to an undisciplined eating behavior. A correction in the sense that the pouch and the connection between the pouch and the small intestine are reduced rarely leads to good results, the weight loss is low and does not last long. Studies are currently underway to determine whether an additional constriction of the stomach pouch with a plastic ring results in an improvement. However, as a rule, a new nutritional consultation and also psychotherapy is required to treat the continuing disorder in food intake.

 

Constrictions (stenosis) between the stomach pouch and the subsequent small intestine are rather rare, usually occur a few weeks after the operation and can usually always be eliminated with a balloon dilation with the help of the gastric level.

 

In about 7% of patients with gastric bypass, ulceration occurs at the transition from the gastric pouch to the small intestine. These ulcers are observed almost exclusively in heavy smokers or in patients who continue to take painkillers from the group of rheumatic drugs. The ulcers can usually be healed with medication. However, it is important that the patient quits smoking and switches the painkillers to stomach-friendly drugs. In extremely rare cases (bleeding, stomach wall breakthrough), surgery is indicated for correction.

 

Summary:

Each operation has its specific risk. The initial interventions for weight loss show a pleasantly low complication rate despite the usually significant concomitant diseases. This does not apply to repeated interventions. Even with reduced weight, the complication rates are significantly higher. If complications occur between 5-7% during the first intervention, the complication rate for the first corrective intervention is 15-25%, for further corrective operations the risk of complications increases to 50%. The correction of an existing method (i.e. correction of a gastric bypass) does not have good results, as a rule, one should switch to another method. In our own experience, we then see patients who benefit very well from the new procedure. But there are also patients who, despite the changed surgical procedure, are only slightly successful