While bariatric surgery offers effective weight loss and health improvement, it may sometimes result in unsatisfactory outcomes or unexpected side effects in both the short and long term. In such cases, the main solution often involves a new surgical intervention, known as revisional bariatric surgery.
As the number of bariatric surgeries continues to increase, the need for revisional surgery has also risen. Today, around 15% of all bariatric procedures performed worldwide are revision surgeries. More than half of the patients requiring revisional surgery experience either insufficient weight loss (defined as losing less than 50% of excess body weight after surgery) or weight regain (defined as regaining more than 25% of the lost weight after initially successful weight loss).
The most commonly performed bariatric procedures are adjustable gastric banding, sleeve gastrectomy, and gastric bypass. Among these, the gastric band is associated with the highest need for revision (30–60%). While sleeve gastrectomy, currently the most widely used procedure worldwide, generally provides better results than the gastric band, it is not without limitations. Scientific studies show that 10–30% of patients undergoing sleeve gastrectomy may require revision surgery in the long term due to weight regain or suboptimal weight loss.
Compared to primary bariatric surgeries, revisional procedures are undeniably more complex and technically demanding. They require high-level surgical expertise and a multidisciplinary approach. Furthermore, both the short- and long-term outcomes of revisional surgeries are usually less favorable than those of initial bariatric operations.
When revision is considered, the most critical step is to analyze the original surgery, identify the cause of failure, and thoroughly evaluate all alternative treatment options. In other words, the approach should not be disease-specific but tailored to the individual patient. Key factors such as the type and technique of the previous surgery, anatomical changes after the operation, current weight status, comorbid conditions, and the experience of the surgical team must all be taken into account when choosing the most appropriate treatment strategy.
Perhaps more important than managing cases requiring revision is preventing the need for revision in the first place. That’s why it is essential to select the most suitable treatment for each patient from the outset and ensure the surgical procedure is performed with optimal technique. Focusing on prevention, rather than correction, should be the priority.
