Bariatric Surgeon Perspective on Revisional Bariatric Surgery (RBS) for Weight Recurrence |
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| Affiliation: | 1. Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana;2. Department of Surgery, Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK;3. Indiana University Health North Hospital, Carmel, Indiana;4. Department of Surgery, Center for Outcomes Research in Surgery, Indiana University School of Medicine, Indianapolis, IN;5. Paul Foster School of Medicine, Texas Tech HSC, El Paso, Texas;6. Department of Surgery, Mayo Clinic, Rochester, Minnesota;7. Department of Surgery, Medical College of Wisconsin, Wauwatosa, WI;1. Center for Clinical and Translational Science and Training, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;2. Division of Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;3. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio;4. Department of Surgery, Lurie Children''s Hospital of Chicago, Chicago, Illinois;5. Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio;6. Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;1. Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, California;2. Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California;3. Department of General Surgery, Creighton University of Phoenix, Phoenix, Arizona |
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| Abstract: | ![]()
BackgroundWeight recurrence (WR) after bariatric surgery occurs in nearly 20% of patients. Revisional bariatric surgery (RBS) may benefit this population but remains controversial among surgeons.ObjectivesExplore surgeon perspectives and practices for patients with WR after primary bariatric surgery (PBS).SettingWeb-based survey of bariatric surgeons.MethodsA 21-item survey was piloted and posted on social media closed groups (Facebook) utilized by bariatric surgeons. Survey items included demographic information, questions pertaining to the definition of suboptimal and satisfactory response to bariatric surgery, and general questions related to different WR management options.ResultsOne hundred ten surgeons from 19 countries responded to the survey. Ninety-eight percent responded that WR was multifactorial, including behavioral and biological factors. Failure of PBS was defined as excess weight loss < 50% by 31.4%, as excess weight loss <25% by 12.8%, and as comorbidity recurrence by 17.4%. Surgeon responses differed significantly by gender (P = .036). 29.4% believed RBS was not successful, while 14.1% were unsure. Nevertheless, 73% reported that they would perform RBS if sufficient evidence of benefit existed. Most frequently performed revisional procedures included conversion of sleeve gastrectomy to Roux-en-Y gastric bypass (RYGB), adjustable gastric band to RYGB, and RYGB revision (21.9% versus 18.2% versus 15.3%, respectively).ConclusionsThis survey demonstrates significant variability in surgeon perception regarding causes and the effectiveness of RBS. Moreover, they disagree on what constitutes a nonsatisfactory response to PBS and to whom they offer RBS. These findings may relate to limited available clinical evidence on best management options for this patient population. Clinical trials investigating the comparative effectiveness of various treatment options are needed. |
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| Keywords: | Revisional bariatric surgery Weight recurrence Survey Surgeon perspectives |
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