After obesity surgery weight loss lasting for 18 months is expected, initial 6 months is fast. Afterwards, weight fixing at a plateau phase and approximately 10% weight gain between 24 to 60 months is expected.
Each weight gain after surgery should not be considered within procedure scope. The most valuable in evaluation is ratio of overweight loss (EWL%). While scientific success limit for EWL post obesity surgery is over 50%, ideal is exceeding 60% to 70%.
WHY YOU GAINED WEIGHT AGAIN?
Basically, we can attach weight gain to 3 reasons.
- Insufficient or technology-incompatible surgery
- Formation of neofundus related to inadequate removal of fundus area in sleeve gastrectomy
- Failure to remove antrum part insufficiently at sleeve gastrectomy
- Leaving stomach wide diameter at sleeve gastrectomy
- Not measuring length of all small intestines at surgeries like gastric bypass or transit bipartition and correspondingly malabsorptive leg remaining short
- Wide anastomosis at gastric bypass
- Patient’s improper diet and living habits
- Consumption of high calorie liquid foods
- Consumption of alcohol
- Junk food
- Diet rich in oil and calories
- Fast-food consumption
- Diet poor in proteins
- Very low-calorie diet at start phase
- No exercise
- Failure to use sufficient vitamins and protein support
- Not discriminating between solids and liquids
- Metabolic response insufficiency
- Patient’s body mass index is very high
- Having diabetes
- Living within obesity limits for a very long time
- In gastric bypass, elongation at small intestine length and increase at absorption functions
The one we most frequently encounter among such three reasons is option three. The underlying reason for success after obesity surgery is hormones secreted from bowels and other organs. In the event of failure to select surgery strong enough to meet needs of patient, we cannot get sufficient metabolic response from patient.
EVALUATION OF PATIENT PRESENTING WITH WEIGHT GAIN AGAIN
- Patient should be imaged endoscopically and with imaging methods if necessary, it has to be evaluated whether technique implemented satisfied conditions.
- Conducting blood tests; metabolic balance of patient is evaluated.
- Conducting blood tests; diabetes status and pancreas reserve are evaluated.
- Patient and next of kin are talked to separately and eating history and post obesity surgery behavior is evaluated.
NON-SURGICAL TREATMENT ALTERNATIVES
- Re-gaining nutrition habits with posh reset diet and taking into suitable diet program
- Including into suitable exercise program
- Evaluating together with psychiatry, arranging necessary medical treatments
- Ensuring restriction of food quantity by slowing gastric emptying with gastric
- Repressing center of appetite with slimming injection
The above alternatives can be implemented individually or in a combination.
First of all, such patients must not have revision surgery indication, medically. However, even if there is revision indication, such treatment alternatives should be given to the patients who do not wish to have surgery again.
TO WHOM WE SHOULD SUGGEST RE-SURGERY
- Those whose overweight loss ratio remains under 50%
- Those whose surgical technique remained insufficient
- Those whose diabetes recurred or emerged
ALTERNATIVES TO REVISION SURGERY
- For Sleeve Gastrectomy
- Re-Sleeve Gastrectomy (can be suggested to patients whose sleeve gastrectomy surgery was not done with suitable technique, neofundus formed or insufficient antrum resection was performed)
- Roux En-Y // Mini- Gastric Bypass (can be suggested to patients whose sleeve gastrectomy was done suitably, however metabolic response remained insufficient or with improper dietary habits)
- Transit Bipartition (can be suggested to patients whose sleeve gastrectomy was done suitably, however metabolic response remained insufficient or with improper dietary habits or whose diabetes re-emerges)
- Duodenal Switch (can be suggested to patients whose sleeve gastrectomy was done suitably, however who have diabetes requiring high doses of insulin)
- For Gastric Bypass
- Adjustable Mesh Gastric Tape (can be suggested to patients whose gastric pouch is enlarged and stomach and small bowel juncture is expanded)
- Transit Bipartition (Those whose malabsorptive leg remained inadequate and suffering from vitamin mineral deficiency)
- Distal Gastric Bypass (Can be suggested to patients whose bowel length extended and absorption functions increased or whose bowel length was not calculated at the beginning)
- Duodenal Switch (Can be suggested to patients whose Bypass is done properly however having diabetes requiring high doses of insulin)