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The safety of additional procedures at the time of revisional bariatric surgery

  • 2020 SAGES Oral
  • Published:
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Abstract

Background

The third most common bariatric operation is revisions of previous bariatric surgeries. Patients may require revisional bariatric surgery for inadequate weight loss or complications. Patients undergoing revisional bariatric surgery may also have other conditions that require surgery. This study evaluates the 30-day postoperative outcomes of patients undergoing revisional bariatric surgery and additional procedures.

Methods

A retrospective review of the 2005–2017 ACS NSQIP database identified 7249 patients who underwent revisional bariatric surgery with 3115 (48%) occurring with additional procedures. A 1:1 propensity score matching analysis was completed for 13 patient demographics and comorbidities. Postoperative variables were then analyzed as available in the NSQIP database. Subgroup analyses were completed for those undergoing paraesophageal hernia repair and abdominal wall hernia repair at the time of revisional bariatric surgery.

Results

The most common bariatric surgery that was converted or revised was the AGB (57%) and the most common additional procedure was paraesophageal hernia repair (n = 181, 15%). When additional procedures were completed at the time of revisional bariatric surgery, overall complications (p < 0.001), major systemic complications (p = 0.009) and mortality/major complications (p = 0.018) were all significantly increased. After matching for operative time, only postoperative sepsis remained significant with additional procedures (p = 0.042). In the subgroup analyses on paraesophageal and abdominal wall hernias there were no differences in postoperative complications after matching for operative time.

Conclusions

Additional procedures, including paraesophageal and abdominal wall hernia repairs at the time of revisional bariatric surgery increase postoperative complications. Operative time was longer when additional procedures were performed. Postoperative sepsis was the only complication which remained significant after propensity matching when additional procedures are completed at the time of revisional bariatric surgery.

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Authors and Affiliations

  1. Department of Surgery, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX, 79930, USA

    Sasha Hornock, Oriana Ellis, Joshua Dilday, Julia Bader & Eric Ahnfeldt

  2. Department of Surgery, Texas Tech Health Sciences Center, El Paso, TX, USA

    Benjamin Clapp

Authors
  1. Sasha Hornock
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  2. Oriana Ellis
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  3. Joshua Dilday
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  4. Julia Bader
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  5. Benjamin Clapp
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  6. Eric Ahnfeldt
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Correspondence to Sasha Hornock.

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Sasha Hornock, Oriana Ellis, Joshua Dilday, Julia Bader, Benjamin Clapp, and Eric Ahnfeldt have no conflicts of interest or financial ties to disclose.

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Hornock, S., Ellis, O., Dilday, J. et al. The safety of additional procedures at the time of revisional bariatric surgery. Surg Endosc 35, 3940–3948 (2021). https://doi.org/10.1007/s00464-020-07856-2

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  • DOI: https://doi.org/10.1007/s00464-020-07856-2

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