REVISIONAL SURGERY
The basic formula of gaining or losing weight is actually quite simple. The difference between a person's daily intake and expenditure determines the speed of that person's weight gain or weight loss. Of course, it is possible to restrict the amount of calories you take with diets. However, low-calorie diets for losing weight, especially for losing weight in a short time, are not sustainable for a long time. Individulas set a goal as “I will lose 10 kilos or 20 kilos”. Some of them are successful in this, some of them are not. According to the data of the World Health Organization, only 2% of those who are successful can maintain their weight in the long term. Because even if the patient reaches the desired weight lost, it mostly returns to lifestyle. It is not possible to change the habits of 20 to 30 years in such a two-month diet period. Your main goal should be to change your lifestyle during the weight loss that takes roughly nine months after these operations. Because none of these surgeries is a magic wand. Each of them has different mechanisms of action and therefore there are different rules to be followed after each one.
We consider multiple criteria while evaluating the success of these surgeries. However, one of the most important criteria for evaluating the success of the bariatric surgery in a person who has been operated due to obesity is excess weight loss rate (EWL%). Let me explain briefly as follows. Imagine a patient who is 160 cm in height and 120 kg in weight. This person's body mass index (BMI) is 46.9 kg / m2. When this person has a body weight of 64 kg, it will have reached the upper limit of the ideal BMI of 25 kg / m2. Therefore, excess body mass is 120-64 = 56 kg. Theoretically, in order for an operation to be considered successful, it is said that the patient should give at least 50% of excess body mass and maintain it for a long term. If we continue on the same patient sample, the operation should reach of at least 28 kg weight loss. However, in reality, this person will continue to live as an obese, weighing 120-28 = 92 kg, and 35.9 kg / m2. This cannot be a measure of success for us. The goal for success should be to deliver and maintain the entire excess weight of the patient. This is only possible by changing the lifestyle. I always compare the effect of these surgeries to weight loss to the rings of a stone thrown into stagnant water. The waves formed in the place where the stone fell are more frequent and their height is higher, then they become sparse and smaller, and even disappear at some point, your weight loss process after surgery is similar to this. You often see that you lose weight every time you weigh, then your weight loss speed slows down and at some point it stops completely. You can get back 10-15% of your weight. The important thing is to maintain the weight you lose at the point where your weight loss stops and the way to do this is to change your lifestyle. From time to time, you may experience temporary pauses in losing weight. You can see that you lose weight in weight due to constipation or fluid retention in the body in the premenstrual period in women. Don't let this break your spirits and stop following the rules. You will continue to lose weight as long as you follow the rules.
When we take a look at the history of obesity surgeries, we see about twenty types of surgery, some of which are in the form of a modification of another type of surgery. The high type of surgery is a direct marker at first glance that an ideal surgery has not yet been found. While these surgeries differ, the goal has always been to get a better and permanent result or to get rid of the problems that arise in a type of surgery. It can be seen that almost a quarter of patients who underwent obesity surgery all over the world had to undergo secondary or sometimes tertiary surgeries after their primary surgery. In obesity support groups, and sometimes even among healthcare professionals, we see that all of these surgeries are called revision surgeries. This nomenclature can sometimes lead to misunderstandings. Let's clarify this issue as well. In a secondary surgery performing in order to eliminate a technical problem that occurs after primary surgery, it should be called as follows: revisional surgery, if the existing problem is resolved without changing the primary surgery type; conevrsional surgery, if the previous surgery type is changed and converted to a different surgery type; redo (or renewal) surgery, if primary surgery is disrupted and the patient's anatomy is restored.
Although there are no healthy data related to the causes of secondary surgical interventions in whole world, the most common reason for weight regain. The first thing to consider in patients with weight regain is whether the primary surgery is technically successful. The second point is whether the patient can change his lifestyle. These two issues are important in determining the surgical methods that can be preferred for the patient. For example, when planning a secondary surgery due to weight regain in a patient who had previously undergone sleeve gastrectomy, it is aimed to disrupt absorption in the secondary surgery if the problem is patient's failure to comply with the nutrition-related rules. On the contrary, if the main problem is the size of the stomach that has been left behind, restricting the volume of the stomach by performing a re-sleeve gastrectomy can be among the alternatives in the selection of surgical methods. Therefore, in the cases requiring secondary surgery, it is essential to evaluate anatomy of patient’s gastrointestinal tract, psychology, feeding characteristics.
In countries such as the United States and the United Kingdom, whether or not the patient complies with the rules regarding low-calorie nutrition before primary operations is tried in order to prevent secondary operations that cause excessive burden on the health system. The successful patients who were complied with the rules are operated. Two of the three main companies that make up health insurance in the U.S. pay only one bariatric surgery for life. In Canada, before the secondary surgeries, the patient is first evaluated by the psychologist, and patients with an eating disorder are marked with a red flag and secondary operations are not performed. When we look in this sense, our country is a paradise for patients who need both primary and secondary surgery. But I can't predict how long this will take.
Let’s go back to the beginning, taking the whole stomach does not provide permanent weight control. The vast majority of patients whose stomachs are removed after surgery due to stomach cancer can maintain their desired weight. Roux-en-Y, or single-anastomosed (or more commonly called mini-gastric) bypasses do not provide permanent weight control if they disable only the initial parts of the small intestine. We know this from patients with stomach cancer. When the stomach is removed in them, the continuity of the feeding system is ensured by a bypass procedure. In this case, the most accurate and harmless method is to change your lifestyle. Unfortunately, if you cannot change this, you have no choice other than malabsorptive methods like duodenal switch.