Gastric sleeve revision in Turkey

• Reflux that will not settle

  The sleeve's characteristic problem. Conversion to a Roux-en-Y gastric bypass is the established answer. A second sleeve does not fix reflux and can make it worse.

• Weight regain or insufficient loss

  Here the options open up: conversion to bypass, conversion to a duodenal switch or SADI-S, or, in selected cases, re-sleeving a stomach that has genuinely dilated.

• A mechanical problem

  A stricture, a twisted sleeve, a hiatal hernia or a leak that never healed. These are found on investigation and each has its own repair.

• Neither, yet

  If the regain follows a return to old eating patterns and nothing mechanical is found, another operation without dietetic and psychological support tends to produce the same outcome again.

If you have not had bariatric surgery yet, the gastric sleeve page covers the primary operation, and the gastric balloon page covers the non-surgical option. For loose skin after weight loss, see plastic surgery after weight loss.

• Conversion to Roux-en-Y gastric bypass. The standard answer for reflux after a sleeve, and a common answer for weight regain. It adds a malabsorptive element and a lifetime of supplementation.
• Conversion to SADI-S or duodenal switch. Used for substantial regain. More weight loss on average and a greater nutritional burden, so it needs a patient who will be followed up.
• Re-sleeve. Only where imaging shows a genuinely dilated sleeve. It does not address reflux and is not a general answer to regain.
• Hiatal hernia repair. Sometimes the reflux is a hernia rather than the sleeve, and repairing it is a smaller operation than a conversion.
• Endoscopic options. Suturing to narrow a dilated sleeve exists and is less invasive, with a different durability profile. Worth asking about before agreeing to open the abdomen again.

• Bring the original operative report. In writing, and if possible the images. Revision planned without it is planned blind.
• Insist on endoscopy before the plan is fixed. Not on the morning of surgery. If the clinic will only scope you on arrival, ask what happens if the findings change the operation and who pays for that.
• Ask how many revisions this surgeon performs. Revision bariatric surgery is a different skill from primary surgery, and volume matters more here than almost anywhere.
• Ask about length of stay and the flight. Longer than a primary sleeve. Leaks declare themselves late, and you want to be near the surgeon when they do.
• Ask who provides lifelong follow-up. Bypass and duodenal switch require permanent supplementation and monitoring. Find out before you travel who does your bloods at home.
• Ask what happens if you present unwell after landing. Which hospital, what letter you carry, and who they will speak to.

• A staged diet again. Liquids, then puree, then soft, then solid, on the schedule your team gives you. The stages are shorter for some revisions and longer for others.
• Supplements are not optional after a bypass or switch. Multivitamin, iron, calcium, vitamin D and vitamin B twelve for life, with blood monitoring.
• Report these immediately. Rapid heartbeat, fever, worsening abdominal pain, shortness of breath or an inability to keep fluids down. These are the signs of a leak.
• Dietetic and psychological support. The difference between a revision that holds and one that does not is usually here, not in the operating theatre.
• Expect slower loss than the first time. Revisions generally produce less weight loss than the original operation did, and knowing that in advance prevents a second disappointment.

• British Obesity and Metabolic Surgery Society, guidance on bariatric surgery and follow-up.
• National Institute for Health and Care Excellence, guidance on obesity management and surgery.
• NHS, information on weight loss surgery and on having surgery abroad.
• International Federation for the Surgery of Obesity and Metabolic Disorders, statements on revisional surgery.
• Turkish Ministry of Health, register of facilities authorised for health tourism.