Long-term follow-up in patients undergoing open gastric bypass as a revisional operation for previous failed restrictive procedures

BackgroundWe have previously described our early experience with Roux-en-Y gastric bypass (RYGB) as a revisional procedure. The favorable results have stimulated us to continue using RYGB as our standard operating procedure after failed bariatric surgery. Our objective was to evaluate the perioperative risks, weight result, and abdominal symptoms 5 years after revisional RYGB surgery at a university hospital in Sweden.MethodsWe studied 121 patients undergoing revisional open RYGB (age 42.0 yr, body mass index 37.7 kg/m², 101 women) 5 years after RYGB surgery. The patients underwent reoperation because of either intolerable side effects or inferior weight loss. The initial procedures were horizontal gastroplasty (n = 2), vertical banded gastroplasty (n = 34), gastric banding (n = 21), and silicone adjustable gastric banding (n = 64). The mean interval between the first surgery and revision was 5 years. The 5-year follow-up data were obtained annually using a questionnaire survey.ResultsThe average operating time was 162 minutes (range 75–355). In these 121 cases, 10 (8%) reoperations were performed in the first 30-day period (4 for leakage). No perioperative mortality occurred, and the 5-year follow-up rate was 91%. The mean body mass index was 30.7 kg/m². Seven patients (5.7%) had undergone subsequent surgery because of complications. At follow-up, 93% reported being very satisfied or satisfied with the revisional procedure. Disturbing abdominal symptoms after RYGB were rare.ConclusionThe perioperative risks of revisional RYGB are greater than those for primary RYGB. However, because the long-term weight results and patient satisfaction are very good, we believe that the 8% reoperative rate is acceptable. We consider RYGB to be a suitable procedure for patients in whom previous bariatric procedures have failed.     

Laparoscopic revisional surgery after Roux-en-Y gastric bypass and sleeve gastrectomy

BackgroundFailure of primary bariatric surgery is frequently due to weight recidivism, intractable gastric reflux, gastrojejunal strictures, fistulas, and malnutrition. Of these patients, 10–60% will undergo reoperative bariatric surgery, depending on the primary procedure performed. Open reoperative approaches for revision to Roux-en-Y gastric bypass (RYGB) have traditionally been advocated secondary to the perceived difficulty and safety with laparoscopic techniques. Few studies have addressed revisions after RYGB. The aim of the present study was to provide our experience regarding the safety, efficacy, and weight loss results of laparoscopic revisional surgery after previous RYGB and sleeve gastrectomy procedures.MethodsA retrospective analysis of patients who underwent laparoscopic revisional bariatric surgery for complications after previous RYGB and sleeve gastrectomy from November 2005 to May 2007 was performed. Technical revisions included isolation and transection of gastrogastric fistulas with partial gastrectomy, sleeve gastrectomy conversion to RYGB, and revision of RYGB. The data collected included the pre- and postoperative body mass index, operative time, blood loss, length of hospital stay, and intraoperative and postoperative complications.ResultsA total of 26 patients underwent laparoscopic revisional surgery. The primary operations had consisted of RYGB and sleeve gastrectomy. The complications from primary operations included gastrogastric fistulas, refractory gastroesophageal reflux disease, weight recidivism, and gastric outlet obstruction. The mean prerevision body mass index was 42 ± 10 kg/m². The average follow-up was 240 days (range 11–476). The average body mass index during follow-up was 37 ± 8 kg/m². Laparoscopic revision was successful in all but 1 patient, who required conversion to laparotomy for staple line leak. The average operating room time and estimated blood loss was 131 ± 66 minutes and 70 mL, respectively. The average hospital stay was 6 days. Three patients required surgical exploration for hemorrhage, staple line leak, and an incarcerated hernia. The overall complication rate was 23%, with a major complication rate of 11.5%. No patients died.ConclusionLaparoscopic revisional bariatric surgery after previous RYGB and sleeve gastrectomy is technically challenging but compared well in safety and efficacy with the results from open revisional procedures. Intraoperative endoscopy is a key component in performing these procedures.     

Revisional bariatric surgery for failed restrictive procedures

BackgroundRevisional bariatric surgery is increasing in frequency, but the morbidity and efficacy have not been well defined. The primary aim of this study was to determine the clinical efficacy with respect to weight loss, and associated morbidity, of revisional bariatric surgery in an academic university hospital bariatric surgery program.MethodsA retrospective review of all patients who underwent revisional bariatric surgery for failed primary restrictive procedures, including gastroplasty and gastric bypass, but not including gastric banding or malabsorptive procedures, during a 10-year period at a single university hospital was performed. The perioperative morbidity and long-term weight loss and clinical results were determined from the medical charts.ResultsA total of 41 patients met the inclusion criteria. The primary bariatric procedures included vertical banded gastroplasty in 20 and Roux-en-Y gastric bypass in 21. The indications for revisional surgery included poor weight loss, weight regain, and various technical problems, including anastomotic stenosis and ulcer. The major morbidity rate was 17%. No patients died. The weight loss results varied depending on the indication for the revisional surgery and reoperative solution applied. The resolution of technical problems was achieved in all patients.ConclusionRevisional bariatric surgery can be performed with minimal mortality, albeit significant morbidity. The efficacy with respect to weight loss appeared acceptable, although the results were not as good as those after primary bariatric surgery. The analysis of patient subsets stratified by surgical history and revisional strategy provided important insights into the mechanisms of failure and efficacy of different revisional strategies.     

Adjustable gastric banding as revisional bariatric procedure after failed gastric bypass—intermediate results

BackgroundAlthough gastric bypass is the most common bariatric procedure in the United States, it is has been associated with a failure rate of 15% (range 5–40%). The addition of an adjustable gastric band to Roux-en-Y gastric bypass has been reported to be a useful revision strategy in a small series of patients with inadequate weight loss after proximal gastric bypass.MethodsWe report on 22 patients who presented with inadequate weight loss or significant weight regain after proximal gastric bypass. All patients underwent revision with the placement of an adjustable silicone gastric band around the proximal gastric pouch. The bands were adjusted at 6 weeks postoperatively and beyond, as needed. Complications and weight loss at the most recent follow-up visit were evaluated.ResultsThe mean age and body mass index at revision was 41.27 years (range 25–58) and 44.8 ± 6.34 kg/m², respectively. Patients had experienced a loss of 19%, 27%, 47.3%, 42.3%, 43%, and 47% of their excess weight at 6, 12, 24, 36, 48, and 60 months after the revisional procedure, respectively. Three major complications occurred requiring reoperation. No band erosions have been documented.ConclusionThe results from this larger series of patients have also indicated that the addition of the adjustable silicone gastric band causes significant weight loss in patients with poor weight loss outcomes after gastric bypass. That no anastomosis or change in absorption is required makes this an attractive revisional strategy. As with all revisional procedures, the complication rates appear to be increased compared with a similar primary operation.     

Long-term follow-up evaluation of revisional gastric bypass after failed adjustable gastric banding

Background

Disappointing long-term results, frequent band failure, and high rates of band-related complications increasingly necessitate revisional surgery after adjustable gastric banding. Laparoscopic conversion to gastric bypass has been recommended as the procedure of choice. This single-center retrospective study aimed to evaluate the long-term results of revisional gastric bypass after failed adjustable gastric banding.

Methods

The study included 108 consecutive patients who underwent laparoscopic conversion of gastric banding to gastric bypass from 2002 to 2012. Indications for surgery, operative data, weight development, morbidity, and mortality were analyzed. The median follow-up period was 3.4 years (maximum, 10 years).

Results

The most common indications for band removal were band migration, insufficient weight loss, and pouch dilation. The median interval between gastric banding and gastric bypass was 6.6 years. In 52 % of the cases, band removal and gastric bypass surgery were performed simultaneously as a single-stage laparoscopic procedure. The early postoperative morbidity rate was 10.2 %. The body mass index before gastric banding (43.3 kg/m²) decreased significantly to 37.9 kg/m² before gastric bypass and to 28.8 kg/m² 5 years after gastric bypass.

Conclusions

This is the first report on the long-term outcome after conversion of failed adjustable gastric banding to gastric bypass. Findings have shown revisional gastric bypass to be a feasible bariatric procedure particularly for patients with insufficient weight loss that guarantees a constant and long-lasting weight loss.     

Revisional Bariatric Surgery for Unsuccessful Weight Loss and Complications

Background

There are growing numbers of patients who require revisional bariatric surgery due to the undesirable results of their primary procedures. The aim of this study was to review our experience with bariatric patients undergoing revisional surgery.

Methods

We conducted a retrospective analysis to review the indications for revisional bariatric procedures and assess their postoperative outcomes.

Results

From 04/04 to 01/11, 2,918 patients underwent bariatric surgery at our institution. A total of 154 patients (5.3 %) of these cases were coded as revisional procedures. The mean age at revision was 49.1?±?11.3 and the mean BMI was 44.0?±?13.7 kg/m². Revisional surgery was performed laparoscopically in 121 patients (78.6 %). Laparoscopic revisions had less blood loss, shorter length of hospital stay, and fewer complications compared to open revisions. Two groups (A and B) were defined by the indication for revision: patients with unsuccessful weight loss (group A, n?=?106) and patients with complications of their primary procedures (group B, n?=?48). In group A, 74.5 % of the patients were revised to a bypass procedure and 25.5 % to a restrictive procedure. Mean excess weight loss was 53.7?±?29.3 % after revision of primary restrictive procedures and 37.6?±?35.1 % after revision of bypass procedures at >1-year follow-up (p?<?0.05). In group B, the complications prompting revision were effectively treated by revisional surgery.

Conclusions

Revisional bariatric surgery effectively treated the undesirable results from primary bariatric surgery. Laparoscopic revisional surgery can be performed after both failed open and laparoscopic bariatric procedures without a prohibitive complication rate. Carefully selected patients undergoing revision for weight regain have satisfactory additional weight loss.     

Magnetic device in reduced port and single port bariatric surgery: First 170 cases experience

IntroductionMagnetic devices have been successfully used in bariatric surgery. To the date, the only reported use of the magnet was for liver retraction. Our purpose in this study is to demonstrate the safety and viability of using a magnetic system in different steps in single port and reduced port bariatric surgery.MethodsProspective and observational study was performed. Patients older than 18 years, undergoing primary laparoscopic sleeve gastrectomy (SG), one-anastomosis gastric bypass (OAGB), and Roux-en-Y gastric bypass (RYGB) or revisional surgery by single-port or reduced-port approach between July 2020 and June 2021 were included.ResultsA total of 170 patients (mean BMI, 41.47kg/m²; mean age 36.92 yrs) completed laparoscopic bariatric surgery (54 single-port sleeve gastrectomy [SPSG], 16 reduced-port SG, 83 RYGB, 4 OAGB and 14 revision surgeries), using the magnetic surgical system in different steps of the surgery. Mean surgical time for SPSG and reduced-port SG was 65.52min and 59.36min respectively; and for RYGB 74.19min, OAGB 70.98min, and revisional surgeries 88.38min. As for intraoperative complications, 2.94% mild liver laceration without significant bleeding was reported. There were no 30-day mortalities and no major complications.ConclusionMagnetic assistance in single-port and reduced-port bariatric surgery is an innovative technique. With this prospective study we attempt to demonstrate the safety profile and potential uses that may improve the implementation of new surgical approaches in bariatric surgery.     

Conversion of one-anastomosis gastric bypass to Roux-en-Y gastric bypass: short-term results from a tertiary referral center

BackgroundOne-anastomosis gastric bypass (OAGB), also known as minigastric bypass, is an increasingly popular bariatric surgery option worldwide. While OAGB offers advantage in terms of procedure time and technical ease, revisional operations to correct complications may be necessary.ObjectivesWe aimed to describe the indications and perioperative outcomes for OAGB conversions to Roux-en-Y gastric bypass (RYGB) at a single-referral center.SettingAcademic hospital, Abu Dhabi, United Arab Emirates.MethodsAll patients undergoing conversion from OAGB to RYGB from February 2016 through September 2018 were retrospectively identified from a prospectively maintained database of revisional bariatric surgeries.ResultsSixteen patients underwent conversion from previous OAGB to RYGB during the study period. The cohort was 62.5% female (n = 10) with a mean age of 40.2 years and median body mass index of 30.7 kg/m². Indications for conversion included intractable nausea/vomiting (n = 8, 50.0%), biliary reflux (n = 3, 18.8%), weight recidivism (n = 3, 18.8%), and protein-calorie malnutrition (n = 2, 12.5%). Twelve cases (75.0%) were successfully completed with a laparoscopic approach, with 4 cases (25.0%) converted to open. The median length of stay was 5.5 days. Six patients (37.5%) experienced minor and major complications within 30 days of discharge. Fourteen patients (87.5%) were available for follow-up at 6 months, with 100% of these patients reporting resolution of their preoperative symptoms. There were no mortalities.ConclusionsData from this largest reported single-center experience demonstrates that conversion of OAGB to RYGB is safe and technically feasible. Further studies and longer-term follow-up are needed to definitively describe outcomes after this revisional bariatric surgery.     

One-year weight loss after primary or revisional Roux-en-Y gastric bypass for failed adjustable gastric banding

BackgroundAdjustable gastric banding has been widely used in Europe, but recently gastric bypass (Roux-en-Y gastric bypass [RYGB]) has become the procedure of choice. With a gastric banding failure rate of nearly 40% at 5 years, the need for revisional surgery is increasing. The effect of a failed previous bariatric surgery on the weight loss curve after RYGB is still a controversial issue.MethodsA total of 259 patients underwent RYGB from 2003 to 2007, 58 after failed gastric banding and 201 as primary surgery. All the procedures were laparoscopically performed by the same surgeon at a single institution. The postoperative course and the percentage of excess weight loss were compared between the 2 groups.ResultsThe 2 groups were similar in age and initial body mass index (46.3 ± 7.2 kg/m² for revision versus 47.7 ± 6.7 kg/m² for primary RYGB). In contrast, the prerevision body mass index was 43.2 ± 7.0 kg/m². Revisional RYGB required a significantly longer operative time (128.3 ± 25.9 minutes versus 89.0 ± 14.7 minutes, P <.0001) and the morbidity was greater (8.6% versus 5.5%), but no patient died in the postoperative period after revision. As determined from the initial body mass index, the 1-year percentage of excess weight loss was comparable between the 2 groups (66.1% ± 26.8% and 70.4% ± 18.9%).ConclusionWhen RYGB is performed after an adjustable gastric band failure to restore weight loss or because of a complication, the weight loss curve is similar to that after primary RYGB. Therefore, the strategy of adjustable gastric banding first is an option that does not seem to preclude satisfactory weight loss after revision to RYGB.     

Midterm results of revisional bariatric surgery postsleeve gastrectomy: resleeve versus bypass

BackgroundBariatric surgery has been shown to produce the most predictable weight loss results, with laparoscopic sleeve gastrectomy (SG) being the most performed procedure as of 2014. However, inadequate weight loss may present the need for a revisional procedure.ObjectivesThe aim of this study is to compare the efficacy of laparoscopic resleeve gastrectomy (LRSG) and laparoscopic Roux-en-Y gastric bypass in attaining successful weight loss.SettingPublic hospital following SG.MethodsA retrospective analysis was performed on all patients who underwent SG from 2008–2019. A list was obtained of those who underwent revisional bariatric surgery after initial SG, and their demographic characteristics were analyzed.ResultsA total of 2858 patients underwent SG, of whom 84 patients (3%) underwent either a revisional laparoscopic Roux-en-Y gastric bypass (rLRYGB) or LRSG. A total of 82% of the patients were female. The mean weight and body mass index (BMI) before SG for the LRSG and rLRYGB patients were 136.7 kg and 49.9 kg/m² and 133.9 kg and 50.5 kg/m², respectively. The mean BMI showed a drop from 42.0 to 31.7 (P < .001) 1 year post revisional surgery for the LRSG group and 42.7 to 34.5 (P < .001) for the rLRYGB group, correlating to an excess weight loss (EWL) of 61.7% and 48.1%, respectively. At 5 years post revisional surgery, LRSG patients showed an increase in BMI to 33.8 (EWL = 45.3%), while those who underwent rLRYGB showed a decrease to 34.3 (EWL = 49.2%). Completeness of follow-up at 1, 3, and 5 years for rLRYGB and LRSG were 67%, 35%, and 24% and 45%, 21%, and 18%, respectively.ConclusionsRevisional bariatric surgery is a safe and effective method for the management of failed primary SG. LRSG patients tended to do better earlier on; however, it leveled off with those who underwent rLRYGB by 5 years.     

Outcome of revisional bariatric surgery for insufficient weight loss after laparoscopic Roux-en-Y gastric bypass: an observational study

BackgroundInsufficient weight loss or secondary weight regain with or without recurrence of comorbidity can occur years after laparoscopic Roux en Y gastric bypass (LRYGB). In selected patients, increasing restriction or adding malabsorption may be a surgical option after conservative measures failed.ObjectivesEvaluation of short and long term results of revisional surgery for insufficient weight loss or weight regain after LRYGB.SettingTertiary hospital.MethodsRetrospective analysis of prospectively collected data from a cohort of 1150 LRYGB patients. Included were patients, who underwent revisional bariatric surgery after LRYGB for insufficient weight loss with a follow-up of minimal 1 year.ResultsFifty-four patients were included in the analysis. After an interdisciplinary evaluation, patients with insufficient weight loss, signs of dumping syndrome, and lacking restriction were offered a nonadjustable band around the pouch (banded group, n = 34) and patients with sufficient restriction, excellent compliance, and adherence were offered a revision to laparoscopic biliopancreatic diversion (BPD group, n = 20). The revisional procedure was performed 3.3 ± 2.3 years after LRYGB in the banded-group and after 6.4 ± 4.3 years in the BPD group (P = .001). Mean body mass index at the time of the primary bariatric procedure was 41.7 ± 6.2 kg/m² in the banded group and 45.2 ± 8.2 kg/m² in the BPD group (P = .08); minimal body mass index between both operations was 29.1 ± 4.7 kg/m² in the banded group and 36.5 ± 9.4 kg/m² in the BPD group, and, at the time of revisional surgery, 31.4 ± 5.5 kg/m² in the banded group and 40.8 ± 6.7 kg/m² in the BPD group (P = .0001). The mean body mass index difference 1 year after revisional surgery was 1.3 ± 3.0 kg/m² in the banded group and 6.7 ± 4.5 kg/m² in the BPD group (P = .01). In the banded group, 11 patients (32.4%) needed removal of the band, 4 patients (11.8%) needed an adjustment, and 4 patients (11.8%) were later converted to BPD. In the BPD group, 2 (10.0%) patients needed revision for severe protein malabsorption.ConclusionsInsufficient weight loss or secondary weight regain after LRYGB is a rare indication for revisional surgery. Banded bypass has modest results for additional weight loss but can help patients suffering from dumping. In very carefully selected cases, BPD can achieve additional weight loss with acceptable complication rate but higher risk for reoperation. Future “adjuvant medical treatments,” such as glucagon-like peptide 1 analogues and other pharmacologic treatment options could be an alternative for achieving additional weight loss and better metabolic response.     

Revision surgery after sleeve gastrectomy: a nationwide study with 10 years of follow-up

BackgroundSleeve gastrectomy is the most common bariatric procedure worldwide. Several studies report good short- and midterm results. However, recent studies report alarming long-term outcomes, in particular about the revision rate.ObjectivesThe aim of this study is the assessment of the revisional rate after sleeve gastrectomy and the analysis of most common reasons for surgical conversion and early complications.SettingThis study is based on a national claims database comprehensive of all bariatric procedures performed in a 10-year period.MethodsThe French Programme De Médicalisation des Systèmes d’Information database was used to identify all patients who underwent sleeve gastrectomy between 2008 and 2018. Codes for diagnoses and procedures were used to describe the reason for and the morbidity of revision surgeries. Multivariate Cox proportional hazard regression analysis was performed to compare the risk of having a revision procedure.ResultsDuring the analyzed period, a total of 224,718 sleeve gastrectomies were performed. The rate of revision surgery after sleeve gastrectomy was 4.7%, 7.5%, and 12.2%, at 5, 7, and 10 years post procedure, respectively. A history of gastric banding was associated with a higher risk of revision (hazard ratio, 2.81; 95% CI, 2.66–2.95; P < .001). The most common revision procedure was gastric bypass (75.2%), followed by resleeve (18.7%). The main reasons for revision surgery were persistence of obesity (87.0%) and gastroesophageal reflux disease (5.2%). After revision surgery, we observed the following complications: 5.1% gastric leak, 18% bleeding, and reoperation rate of 6.4%.ConclusionsThis study suggests that a large number of patients who initially underwent a sleeve gastrectomy will undergo a revisional surgery. This information should be considered in the initial choice of the bariatric procedure, and patients should be informed of the mid- and long-term risks.     

Revisional bariatric surgery to single-anastomosis gastric bypass: a large multi-institutional series

BackgroundReoperation is often required after bariatric procedures. Single-anastomosis gastric bypass (SAGB) is increasingly utilized as a primary bariatric procedure. Few series document SAGB as a revisional bariatric procedure.ObjectivesTo describe our short-term experience with revisional SAGB, focusing on weight loss and reflux symptom outcomes.SettingThree hospitals in Australia with both private and public (government funded) patients.MethodsWe reviewed all revisional SAGB cases from 2012 to 2019 at. Complications were considered significant if they were Clavien-Dindo grade 3a or higher. A phone survey was conducted to assess weight loss outcomes, patient satisfaction, reflux symptoms, and other complications.ResultsWe identified 254 patients who had a revisional bariatric procedure to SAGB (21 previous sleeve gastrectomies and 233 previous adjustable bands), with a mean follow-up of 22 ± 15.6 months (range, 1–55 mo). The mean percentage of excess weight loss was 77% (183 patients, 72%), and the number of patients with follow-ups at 1 and 4 years was 184 (73%) and 35 patients (14%). Within 30 days, there were 29 patients (11%) who required reinterventions (21 endoscopies, 1 interventional radiology procedure, and 7 reoperations) with no deaths. Beyond 30 days, 27 patients (11%) required rerevision to Roux-en-Y gastric bypass for reflux symptoms and 10 (4%) required a laparotomy or laparoscopy for another reason (e.g., bowel obstruction). At a median follow-up of 36.6 months, 87 patients (34%) completed a phone survey, 45 (52%) of whom were taking proton pump inhibitors and 66 patients (76%) of whom were satisfied with their experience.ConclusionIn our series, revision to SAGB was safe, with low short-term morbidity and favorable weight loss outcomes. However, beyond 1 year, a large proportion of patients experienced severe reflux symptoms and required rerevision.     

Metabolic outcomes after revisional bariatric surgery: a systematic review and meta-analysis

BackgroundIt has been well-established that primary bariatric surgery is effective in inducing improvement of diabetes and other associated co-morbidities in patients with obesity. Evidence demonstrating the influence of revisional bariatric surgery on this trajectory, however, is lacking.ObjectivesWe performed a systematic review and meta-analysis to examine the impact of revisional bariatric surgery on obesity-related metabolic outcomes.SettingUniversity Hospital, SingaporeMethodsWe examined outcomes of remission and improvement of diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea. Revisional surgeries included sleeve gastrectomy, Roux-en-Y gastric bypass, pouch revision, duodenal switch, and minigastric bypass.ResultsOur search identified 33 relevant studies including a total of 1593 patients. Meta-analysis of proportions demonstrated a 92% improvement in diabetes with 50% achieving remission after revisional bariatric surgery. Of patients, 81% achieved improvement of hypertension with 33% achieving complete remission. In both groups, the highest proportion of improvement was observed after revisional duodenal switch. Although reported by fewer studies, a remission of hyperlipidemia was reported in 37% of patients and improvement of obstructive sleep apnea was seen in 86% of patients.ConclusionsRevisional bariatric surgery improves the outcomes of obesity-related co-morbidities and should be considered in patients with persistent metabolic disease after primary bariatric surgery.     

Comparison of robotic revisional weight loss surgery and laparoscopic revisional weight loss surgery using the MBSAQIP database

BackgroundThe most common bariatric operation in the United States is sleeve gastrectomy. The second and third most common bariatric operations are gastric bypass and revisional bariatric surgery, respectively.ObjectiveThe objective of the study was to assess the differences between laparoscopic revisional weight loss surgery (LRWLS) and robotic revisional weight loss surgery (RRWLS).SettingUniversity hospital, United States.MethodsData were extracted from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database spanning 2015 to 2016 to look at demographic characteristics, operative time, co-morbidities, and length of stay. Using the specified Current Procedural Terminology codes, patients who underwent bariatric procedures and required a revisional procedure were identified.ResultsA total of 354,865 patients were included in this study; 37,917 (11.9%) patients required revision after undergoing a bariatric procedure. Of these revisions, 94.9% (n = 35,988) were LRWLS, and 5.1% (n = 1929) were RRWLS. There were no differences in patient characteristics between the LRWLS and RRWLS groups. There was a significant difference between the RRWLS and the LRWLS groups in operative time, with the RRWLS group taking 167 minutes and the LRWLS group taking 103 minutes (P < .001). There was a statistically significant increase in length of stay for RRWLS, 2.3 days versus 1.7 for LRWLS (P < .005). In terms of postoperative complications, there were no significant differences between the 2 groups.ConclusionsRRWLS is as safe as LRWLS in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. There is an increase in operative times and length of stay for robotic cases.     

Effect of Revisional Bariatric Surgery on Weight Loss and Frequency of Complications

Background: The relative risks and effectiveness of primary and revision operations done to produce weight loss are of interest both from a patient care and an economic perspective. The possibility that patients requiring revision surgery comprise a treatment resistant subgroup who are more likely to have post-operative complications is a valid concern. Methods: The records of all patients having bariatric procedures since January of 1970 were evaluated for weight loss and complications. Results: Most revisions were from jejunoileal bypass or a gastric restrictive procedure. Early complications were significantly more common following revision surgery (19%) than after primary procedures (6%), although late and combined early and late complication rates were similar. Operative mortality was lower following primary procedures (2/382) than revisions (1/75). Cholecystectomy was a common sequela following primary procedures but did not occur after revision procedures. Regardless of surgical category, weight loss after revision was equivalent to weight loss after primary procedures. Conclusions: Weight loss following revisional bariatric surgery is equivalent to weight loss following a primary operation of the same type. Although mortality and early complications are more common after revisional bariatric surgery, the frequency of late complications is not different. In all groups wound infections and hernias were relatively common complications and cholecystectomies are rare after revisional bariatric operations.     

A two-decade spectrum of revisional bariatric surgery at a tertiary referral center.

BACKGROUND: Ineffective weight loss or complications of previous bariatric surgery often require revisional bariatric procedures. Our aim was to define the indications, operative approach, and outcomes of revisional bariatric procedures during 2 decades at a tertiary center. METHODS: From our prospective database (n = 1584), including 1985-2004, 218 patients (14%) underwent revisional bariatric procedures. Follow-up (mean 7 yr, range 1 mo to 19 yr) data obtained from patient records and questionnaires were current for 98%. Patients were grouped according to operative indications: group 1, unsatisfactory weight loss (n = 97); group 2, mechanical/symptomatic complications (n = 95); and group 3, severe nutritional/metabolic problems (n = 26). RESULTS: The operative mortality rate was 0.9% (1 case each of pulmonary embolus and cardiac arrest). The serious operative morbidity rate was 26% (wound infection in 13%, leak in 3%, pulmonary embolus in 2%, anemia/hemorrhage in 2%, pneumonia/prolonged ventilation in 2%, and other in 4%). Of the 218 patients, 94% underwent conversion to, or revision of, Roux-en-y gastric bypass. Group 1 achieved substantial weight reduction with a mean body mass index from 51 +/- 1 to 38 +/- 1 kg/m(2), the complications resolved in 88% of group 2, and the nutritional/metabolic problems resolved in 79% of group 3. Patients who underwent revisional surgery 1990 were more likely to present with mechanical/symptomatic/metabolic complications than for unsuccessful weight loss (P <.001). CONCLUSIONS: Revisional bariatric surgery is safe and effective in experienced centers. Complications (mechanical/symptomatic/nutritional) or unsatisfactory weight loss after primary bariatric procedures can be treated effectively with revision to Roux-en-y gastric bypass.     

Revisional bariatric surgery is more effective for improving obesity-related co-morbidities than it is for reinducing major weight loss

BackgroundPatients having previous bariatric surgery are at risk for weight regain and return of co-morbidities. If an anatomic basis for the failure is identified, many surgeons advocate revision or conversion to a Roux-en-Y gastric bypass. The aim of this study was to determine whether revisional bariatric surgery leads to sufficient weight loss and co-morbidity remission.Patients and MethodsFrom 2005-2012, patients undergoing revision were entered into a prospectively maintained database. Perioperative outcomes, including complications, weight loss, and co-morbidity remission, were examined for all patients with a history of a previous vertical banded gastroplasty (VBG) or Roux-en-Y gastric bypass (RYGB).ResultsTwenty-two patients with a history of RYGB and 56 with a history of VBG were identified. Following the revisional procedure, the RYGB group experienced 35.8% excess weight loss (%EWL) and a 31.8% morbidity rate. For the VBG group, patients experienced a 46.2% %EWL from their weight before the revisional operation with a 51.8% morbidity rate. Co-morbidity remission rate was excellent. Diabetes (VBG:100%, RYGB: 85.7%), gastroesophageal reflux disease (VBG: 94.4%, RYGB: 80%), and hypertension (VBG: 74.2%, RYGB:60%) demonstrated significant improvement.ConclusionRevision of a failed RYGB or conversion of a VBG to a RYGB provides less weight loss and a higher complication rate than primary RYGB but provides an excellent opportunity for co-morbidity remission.     

Predictive factors of complications in revisional gastric bypass surgery: results from the Scandinavian Obesity Surgery Registry

BackgroundRoux-en-Y gastric bypass is the most common procedure for revisional bariatric surgery. This study is an analysis of revisional gastric bypass operations (rGBP) compared with primary gastric bypass (pGBP) performed in Sweden between 2007 and 2016.ObjectiveThe aim was to compare the incidence of adverse events in primary and revisional gastric bypass surgery and to identify predictive factors of intraoperative, early, and late complications in revisional gastric bypass surgery.SettingForty-four hospitals.MethodsRegistered study from the Scandinavian Obesity Surgery Registry. The study group (rGBP) comprised 1795 patients, and the control group (pGBP) comprised 46,055 patients.ResultsMedian follow-up time was 28 months. The rate of open procedures was significantly higher in the rGBP group (39.1% versus 2.4%; P < .001) decreasing from 70.8% in 2007 to 8.5% in 2016. Intraoperative complications (15.5% versus 3.0%, P < .001), early complications (24.6% versus 8.7%; P < .001), and late complications (17.7% versus 8.7%; P < .001) occurred more often in the rGBP group. Open access in revisional surgery was an independent risk factor for intraoperative complications (odds ratio 3.87; 95% confidence interval: 2.69–5.57, P < .001), early complications (odds ratio 2.08; 95% confidence interval: 1.53–2.83, P < .001), and late complications (odds ratio 1.91; 95% confidence interval: 1.31–2.78, P = .001). Indication for revision or type of index operation were not associated with complications.ConclusionRGBP was associated with a higher incidence of intraoperative, early, and late complications compared with pGBP. Open access in revisional surgery was predictive of complications regardless of the index operation or indication for revision.     

Revisional bariatric surgery: perioperative morbidity is determined by type of procedure

Background

Revisional bariatric procedures are on the rise. The higher complexity of these procedures has been reported to lead to increased risk of complications. The objective of our study was to compare the perioperative risk profile of revisional bariatric surgery with primary bariatric surgery in our experience.

Methods

A prospectively maintained database of all patients undergoing bariatric surgery by three fellowship-trained bariatric surgeons from June 2005 to January 2013 at a center of excellence was reviewed. Patient demographics, type of initial and revisional operation, number of prior gastric surgeries, indications for revision, postoperative morbidity and mortality, length of stay, 30-day readmissions, and reoperations were recorded. These outcomes were compared between revisional and primary procedures by the Mann–Whitney or Chi square tests.

Results

Of 1,556 patients undergoing bariatric surgery, 102 patients (6.5 %) underwent revisional procedures during the study period. Indications for revisions included inadequate weight loss in 67, failed fundoplications with recurrent gastroesophageal reflux disease in 29, and other in 6 cases. Revisional bariatric procedures belonged into four categories: band to sleeve gastrectomy (n = 23), band to Roux-en-Y gastric bypass (n = 25), fundoplication to bypass (n = 29), and other (n = 25). Revisional procedures were associated with higher rates of readmissions and overall morbidity but no differences in leak rates and mortality compared with primary procedures. Band revisions had similar length of stay with primary procedures and had fewer complications compared with other revisions. Patients undergoing fundoplication to bypass revisions were older, had a higher number of prior gastric procedures, and the highest morbidity (40 %) and reoperation (20 %) rates.

Conclusions

In experienced hands, many revisional bariatric procedures can be accomplished safely, with excellent perioperative outcomes that are similar to primary procedures. As the complexity of the revisional procedure and number of prior surgeries increases, however, so does the perioperative morbidity, with fundoplication revisions to gastric bypass representing the highest risk group.