Revisional Bariatric Surgery - Safe and Effective |
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Authors: | Kenneth B Jones Jr MD FACS |
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Institution: | (1) Christus Schumpert Health System and Doctors Hospital, Shreveport/Bossier City, LA, USA |
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Abstract: | Background: Revision operations have traditionally been considered difficult and associated with a high complication and long-term
failure rate. This paper demonstrates that revision and/or conversions to Roux-en-Y gastric bypass are generally safe as well
as effective in long-term weight maintenance and control of co-morbidities. Methods: A retrospective study from January 1989
through August 1999 was done involving 141 patients who had had various gastroplasty (118), gastric banding (6), jejunoileal
bypass (3), or loop (2) and Roux-en-Y gastric bypass (RYGBP) procedures (12), with either technical failures or poor long-term
maintained weight loss. Results:The demographics were: mean pre-operative weight at original surgery 264 lbs (120 kg); postop
weight at a mean elapsed time since surgery of 5 years, 4 months: 188 lbs (85 kg), or a mean excess weight loss of 59%. The
mean BMI dropped from a pre-op 45 to a post-op 31.There were 7 complications which required emergency surgery (5%), which
included 4 leaks, 2 subphrenic abscesses, and 1 wound dehiscence. Other complications included 4 hernias, 3 staple-line failures,
1 transient renal failure, and 3 incidences of peptic ulcer disease requiring surgery, giving a total major complication rate
of 13% in 17 patients, with no deaths. An earlier experience of this author comparing conversion RYGBP vs revision gastroplasty
found better morbidity rates and weight loss with those converted to RYGBP. Conclusion: Converting failed gastric limiting
and other bariatric procedures to RYGBP was safe and effective. Technical approaches to each problem type encountered are
presented. |
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Keywords: | REVISION BARIATRIC SURGERY MORBID OBESITY GASTRIC BYPASS GASTROPLASTY GASTRIC BANDING JEJUNOILEAL BYPASS |
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