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[Introduction]
With the increase in the number of bariatric surgery performed every year, there are growing numbers of patients who require revisional surgery due to undesirable results from their primary procedures. Anatomic complications and weight regain are the two most common reasons for pursuing revisional bariatric surgery.
[Methods]
We conducted a retrospective analysis from a single institution to evaluate medium-term weight loss and complication rates after revisional bariatric procedures.
[Results]
From 01/04 to 01/11, 2918 patients underwent bariatric surgery at our institution. 155 (5%) had revisional surgery. 81% were female. The mean age at revision was 49 and the mean BMI at time of revision was 44. The most common primary procedures were Roux-en-Y gastric bypass (RYGB) (n=55, 36%), vertical banded gastroplasty (n=37, 24%), sleeve gastrectomy (SG) (n=26, 17%), and adjustable gastric banding (AGB) (n=23, 15). Two groups were defined according to the indication for revision. Group A included patients with unsatisfactory weight loss or regain of co-morbidities (n=108) and Group B included complications from their primary procedures (n=47). In group A, majority of the patients (69%) were revised to standard or distal RYGB. Others underwent redo gastrojejunostomy, placement of AGB over a large gastric pouch or stoma, or SG. Mean excess weight loss at 1 year follow up was 56% after revision of primary restrictive procedures and 40% after primary bypass procedures (p<0.01). At mean follow up of 3 years, EWL was 48% and 37%, respectively (p=0.08). In group B, 77% of the patients were revised to RYGB. The complications prompting revision (recalcitrant gastrojejunal stricture, refractory marginal ulcer, severe gastroesophageal reflux disease, and malnutrition) were effectively treated by revisional surgery. The mean BMI in Group B was 30 at the time of revision and was 32 at 3 years. Revisional surgery was performed laparoscopically in 121 patients (78%). Major and minor complications were observed in 13 and 17 %, respectively, of those who had laparoscopic surgery and 29 and 35 %, respectively, of those who had open surgery (p<0.05). Open revisions had greater blood loss (p<0.01), and longer length of hospital stay (p<0.01) compared with laparoscopic revisions. Mortality was seen in 1 patient (0.6%) 5 months after open surgery.
[Conclusion]
Revisional bariatric surgery was performed effectively to manage undesirable results from primary bariatric surgery. Laparoscopic revisional surgery can be performed safely in the majority of these patients. Carefully selected patients undergoing revision for weight regain have satisfactory additional weight loss.