REVISIONAL BARIATRIC SURGERY AT A SINGLE INSTITUTION: RESULTS FROM A NEW TERTIARY REFERRAL ACADEMIC MEDICAL CENTER IN THE MIDDLE EAST
Juan S. Barajas-Gamboa*, Ricard Corcelles, Joshua P. Landreneau, Carlos Abril, Andrew T. Strong, Zdenko Boras, Ahmed E. Al Zubaidi, Javed Raza, Matthew Kroh
Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
BACKGROUND
Bariatric surgery is an effective and durable intervention for weight loss and co-morbid diseases. Long-term follow-up demonstrates a number of patients that fail to achieve initial adequate weight loss, regain weight after a nadir, or experience complications. For any of these reasons, revision bariatric surgery may be considered. The aim of this study is to evaluate the results and outcomes for a series of patients undergoing revision and conversion at a new tertiary referral, North-American-styled academic medical center in the Middle East.
METHODS
All patients undergoing revisional bariatric procedures from the opening of the hospital in September 2015 through November 2018 were retrospectively reviewed with IRB approval at a single institution through a prospective database. Indications for surgery and perioperative outcomes were analyzed.
RESULTS
One hundred twenty one patients underwent conversion or revision during the time period, representing 34.5% of all bariatric procedures performed. The most common conversion was to RYGB (95%) or distalization due to weight regain after RYGB (5%). All primary operations were performed at other facilities. Three most common primary procedures performed prior to reoperation were: Sleeve Gastrectomy (SG) 71 (58.6%), Minigastric Bypass (MGB) 18 (14.8) and Gastric Banding (GB) 14 (11.5 %). 32.2% underwent re-intervention for weight regain, and 67.8% underwent revision or conversion for complication. The cohort was 71% female (mean age of 39 years). Median BMI at the time of conversion was 37 kg/m2. Comorbidities included gastroesophageal reflux disease (GERD) (n=70, 57.8%), hyperlipidemia (n=28, 23.1%), hypertension (n=23, 19%), diabetes mellitus (n=19, 15.7%), obstructive sleep apnea (n=10, 8.2%) and coronary artery disease (n=5, 0.4%). Primary indications for conversion were GERD (n=40, 33%), weight regain (n=39, 32.2%), chronic nausea, vomiting, and/or dysphagia (n=36, 29.7%), fistula (n=3, 2.4%), malnutrition (n=2, 1.6%) and gastroparesis (n=1, 0.8%). Three most common mechanical complications were hiatal hernia (n=18, 14.8%), stenosis or stricture (n=13, 10.7%), and twist (n=12, 9.9%). Median operative time was 194 (+/- 45.3 minutes). Median postoperative length of stay was 6 days. Complications within 30 days included early minor complications (nausea/vomiting, trocar/surgical site infection, ileus) (n=11, 9%) and early major complications (anastomosis leak, hemorrhage, sepsis) (n=8, 6,6%). Readmission rate within 30 days was (8.2%). Median BMI at 12-months was 30 (20-39 kg/m2). No mortalities at a median follow-up of 24 months.
CONCLUSION
In this series, representing the largest reported single-center experience in the gulf region, conversion and revision are safe options for patients with weight regain or complications after primary bariatric surgical procedures.
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