In all obesity surgeries, there is a possibility of gaining weight again, albeit low. By performing a second surgical procedure, these patients can be helped to lose the weight they gained if they have regained it, or to start losing weight again if they have stopped losing weight. All of these secondary procedures are called revision surgery. Which Patients Is Revision Surgery Applied To? It can be applied to all patients who have previously undergone obesity surgery with any method and have regained weight or who have not been able to lose sufficient weight. However, the method to be applied to each patient is different. Therefore, not every method can be applied to every patient. Again, all of these procedures can be performed laparoscopically (closed). By whom and where is revision surgery performed? Revision surgeries were very specialized surgeries and required serious experience and skill. The physician and unit that will perform the procedure should preferably have all of the following features. A lot of laparoscopic surgery experience (at least 2000 laparoscopic surgeries and at least 1000 obesity surgeries) Being able to perform all kinds of obesity surgery. Being able to perform endoscopic evaluation and procedure and having a fully equipped endoscopy unit. Having the procedure done in a fully equipped hospital where all relevant branches and intensive care services can be provided. Sugar Do diseases such as disease, asthma, blood pressure prevent revision surgery? On the contrary, these are diseases caused and exacerbated by obesity. These diseases are not an obstacle but a reason for surgery. How to prepare before revision surgery? What tests are performed? First of all, detailed information about the patient's previous surgery should be obtained. First, an epicrisis on surgery and diseases should be found. Endoscopy should preferably be performed by the physician who will perform the surgery. In addition to endoscopy, these patients may experience complications related to previous surgery. Barium radiographs, medicated abdominal tomography or medicated magnetic resonance imaging methods may also be required to better understand the anatomical changes. Tomography Apart from this, the following tests and examinations are performed on each patient before the surgery, as if they were having surgery for the first time; Blood Biochemistry tests Hemogram Hormone tests Hepatitis tests Whole abdominal ultrasound Stomach endoscopy (with anesthesiologist) ECG (Heart X-ray) Chest X-ray Lung breathing test If necessary, stress test and ECO (Electrocardiography) After all these tests, Anesthesia, Internal Medicine, Cardiology, Chest Necessary examinations and examinations are carried out by diseases and endocrine specialists. As a result of these examinations, it is first checked whether there is any other underlying disease that may cause the patient to gain weight. If there is no such disease, the patient is examined for anesthesia like any patient who will undergo surgery, and it is checked whether there is any obstacle to the surgery. Relevant experts make recommendations about preoperative treatments, if necessary. In this way, problems that may occur during and after the surgery are minimized. How is revision surgery performed? Some non-surgical procedures can be performed with endoscopy. Other than that, all procedures are performed by laparoscopic (closed) surgery method, regardless of the method. Here, the experience of the physician performing the procedure becomes much more important. Laparoscopic surgery is performed by making many small incisions. Ports placed through these incisions are used to allow hand tools to reach the abdomen. One of these is a surgical telescope connected to a video camera, and the others are for insertion of specialized surgical instruments. The surgeon watches the operation on a video monitor. With experience, an experienced laparoscopic surgeon can perform many procedures laparoscopically, just like open surgery. What is revision surgery? r can be done, what are the different applications? Patients with Gastric Band: In these patients, the band is first removed. This process may occur in one session or in different sessions. In some patients, the band penetrates into the stomach and it may be necessary to remove the band endoscopically. After the band is removed, the patient can undergo any surgical procedure as if he had never had surgery. b.In the patient with gastric bypass; First of all, if the passage between the stomach and intestine is widened, the passage can be narrowed with endoscopy and sclerotherapy in three or four sessions. In this way, the patient feels full for a longer time since the food remains in the stomach for a longer time. The intestinal loop connected to the stomach can be separated and reconnected further. In this way, the amount of calories consumed decreases since less part of the intestines comes into contact with food. By performing a bypass between the intestines, the relationship of the intestines with food can be limited. In patients with sleeve gastrectomy (sleeve gastrectomy): First of all, if the first surgery was not sufficient or the stomach has expanded again, a sleeve can be performed again. Roux-en-Y (proximal) can be applied. This variant is the most commonly used gastric bypass technique and the most performed bariatric procedure in the United States. It is the operation that causes the least nutritional problems. A proximal gastric pouch, smaller than 30 mL, is created at the entrance of the stomach. This new stomach pouch has a volume smaller than approximately 1 tea glass. By creating a gastric pouch, the existing stomach is disabled and nutrients are allowed to come here. Approximately 50-75 cm is cut from the part of the small intestine leading towards the distal (large intestine) and connected to the new stomach pouch created. The remaining end of the small intestine, from which bile and pancreatic fluid come, is approached and rejoined to the intestine 70-80 cm away. Duodenal switch. In this procedure, the duodenum is separated and transferred here. Connection is made from the part of the small intestine that goes towards the distal (large intestine). In this way, foods come into contact with less intestinal surface. Transit bipartition. This process also improves diabetes, especially in people with diabetes. A mouthpiece is made from the part of the small intestine that goes towards the distal (large intestine) near the stomach exit. In this way, half of the food travels through the entire intestine and the other half goes directly to the end of the intestine. This both reduces weight gain and relieves the patient of insulin use by controlling sugar. Gastric Bypass, Roux-en-Y (distal) Normal small intestine is between 600-1000 cm. The end of the intestine from which bile comes is connected to the intestine from which food comes from about 1 meter further. The combination of bile with food towards the end of the small intestine causes malabsorption (reduced absorption) mainly of fats and starches, but also of various minerals and fat-soluble vitamins. Unabsorbed fats and starch pass into the large intestine. This can provide faster weight loss. However, more serious nutritional problems (such as serious vitamin deficiency) may occur. Additionally, bacterial activity here may cause the production of irritating substances and the formation of foul-smelling gas. Is leak testing performed in revision surgery? A leak test is performed during revision surgery and then on the 2nd day. The purpose of the leak test performed during surgery is to determine whether there is a problem with the staples or whether there is a leak in the suture line. If there is a leak, additional stitching is placed on the relevant part to prevent leakage. Again, before starting liquid foods after the surgery, a leak test is performed to ensure that the necessary precautions are taken and intervened in a timely manner. Are there any stitches in revision surgery? In obesity surgeries, additional stitches are placed on special materials called staplers. is controversial. Some surgeons think that stitching reduces the possibility of bleeding and leakage and that stitches should be placed on every patient. Some surgeons say that although stitching reduces the possibility of bleeding to some extent, it does not reduce the risk of leakage; on the contrary, it may cause more leakage and bleeding after vascular injury while stitching. Our clinical approach is between these two. Although we do not put additional stitches on every patient, if the stapler line does not seem safe enough to us, we definitely put additional stitches. The fact that our results are much better than the world averages shows that the method we apply is more successful. The most important point here is that the surgeon performing the surgery must have the ability and experience to intervene and correct all kinds of problems. Why are blood thinners used in revision surgery? During any surgery, there is a possibility of a blood clot in the vein and blocking any vein. This can cause serious problems when it is a blood vessel that feeds vital organs such as the heart, lungs and brain. As the weight of patients increases, the risk of embolism also increases. For this purpose, these patients are given blood thinners regardless of the surgery they undergo. Although it slightly increases the risk of bleeding, its benefit is much higher. The use of blood thinners begins before surgery and continues for two more weeks. The duration of use may be longer in patients at high risk, such as patients with cardiovascular disease or those who have previously experienced an embolism. Is there pain after revision surgery? Will there be a scar after revision surgery? Since revision surgery is performed laparoscopically (closed), that is, by entering through millimetric holes, postoperative pain is much less than open surgery. However, the statement "There was surgery, of course there will be pain" is extremely wrong. twenty first century No patient should experience pain during the year. Pain is completely prevented by administering painkillers to each patient after surgery. The important point here is this. Everyone's pain threshold is different. Again, drug tolerance and drug bioavailability are different. Therefore, treatment cannot be standard. Pain relief treatment should be arranged individually according to the needs of each patient. Since the incisions are very small, the aesthetic results are also extremely good. After a few months, these lines will become almost invisible. After the wounds heal, you will be recommended a cream to leave fewer scars. If you use it for three months, you will get much better aesthetic results. When will nutrition start after revision surgery? You will start taking liquid food after the leak test is performed on the 2nd day of the surgery. After the first two weeks of liquid nutrition, you will be fed soft (mashed) food for another two weeks. You will be in constant communication with our dietitians throughout this entire process. What will nutrition, vitamin and mineral supplements be like after revision surgery? Patients are given protein supplements for the first 15 days. Various vitamin and mineral supplements are given to patients, especially in the first year. Protein and vitamin usage times vary depending on the type of surgery performed. These are not standard for every patient, and decisions are made according to the patient's condition and what and how much he needs after the examinations performed during routine checks. Can I stand up and return to work immediately after revision surgery? Since the surgery is performed laparoscopically (closed), you can stand up and walk an hour or two after the surgery. You will not be a nursing patient even during your stay in the hospital, you will be able to do your own self-care. Patients who work at a desk or in jobs that do not require heavy effort will be able to wait for a week. They can also start back to work. Patients who require heavy effort should take a break from work for at least a month. After the surgery, patients are given a rest period for a sufficient period of time. When are stitches removed after revision surgery? Since self-absorbing stitches are often used, there is no need to remove stitches. If non-absorbable stitches are used for a different reason, when you come for control on the tenth day, the stitches will be checked and removed if appropriate. Revision surgery
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