Obesity Surgery

, Volume 19, Issue 7, pp 827–832 | Cite as

Revisional Bariatric Surgery

  • C. S. H. LimEmail author
  • V. Liew
  • M. L. Talbot
  • J. O. Jorgensen
  • K. W. Loi
Research Article



Revisional surgery is required in a significant number of patients because of failure to lose weight, loss of quality of life, weight regain, or complications of the previous procedure. It has traditionally been associated with higher complication rates, and there appears to be no standardized surgical approach to revisional surgery. The aim of the study was to review the revisional procedures performed at St George Private Hospital and analyze the outcomes of the different types of revisional surgery.


We performed a retrospective review of 75 patients who underwent revisional surgery between December 2003 and October 2007. Demographic, anthropometric, perioperative, and clinical follow-up data were collected, and statistical analyses were performed using SPSS version 14.0.


Sixty-six of the 75 patients were female. The mean age at the time of revision was 46.32 (22–68) years. Mean initial weight was 119.08 kg, and body mass index (BMI) was 43.42 kg/m2. The lowest BMI and excess weight loss (EWL) recorded after primary surgery was 36.9% and 53.5%, respectively. At the time of revision, the mean EWL was 24.79. The EWL at 3 months and 6 months were 41.7% and 47.8%, respectively. Revision was performed laparoscopically in 51 patients and via laparotomy in 24 patients. There was no mortality in the cohort, but there were 17.3% minor and 4.0% major perioperative morbidities.


Our study suggests that revision can be performed safely. Weight loss is satisfactory, and complications of the previous operations were all reversed. Furthermore, revisions may be done laparoscopically, including those who had previous open procedures.


Revision Bariatric surgery Morbid obesity Laparoscopy Gastric bypass Gastric band Sleeve gastrectomy 


  1. 1.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta analysis. JAMA 2004;292:1724–37.CrossRefGoogle Scholar
  2. 2.
    Colquitt J, Clegg A, Loveman E, et al. Surgery for morbid obesity. Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No.: CD003641. doi: 10.1002/14651858.CD003641.pub2.
  3. 3.
    Gagner M, Gentileschi P, deCsepel J, et al. Laparoscopic reoperative bariatric surgery: experience from 27 consecutive patients. Obes Surg 2002;12:254–60.CrossRefGoogle Scholar
  4. 4.
    Sugerman HJ, Kellum JM Jr, DeMaria EJ. Conversion of failed or complicated vertical banded gastroplasty to gastric bypass in morbid obesity. Am J Surg 1996;171:263–7.CrossRefGoogle Scholar
  5. 5.
    Behrns KE, Smith CD, Kelly KA, et al. Reoperative bariatric surgery. Lessons learned to improve patient selection and results. Ann Surg 1993;218:646–53.CrossRefGoogle Scholar
  6. 6.
    Benotti PN, Forse RA. Safety and long-term efficacy of revisional surgery in severe obesity. Am J Surg 1996;172:232–5.CrossRefGoogle Scholar
  7. 7.
    Ortega J, Sala C, Flor B, et al. Vertical banded gastroplasty converted to Roux-en-Y gastric bypass: little impact on nutritional status after 5-year follow-up. Obes Surg 2004;14:638–43.CrossRefGoogle Scholar
  8. 8.
    Calmes JM, Giusti V, Suter M. Reoperative laparoscopic Roux-en-Y gastric bypass: an experience with 49 cases. Obes Surg 2005;15:316–22.CrossRefGoogle Scholar
  9. 9.
    Van Gemert WG, Van Wersch MM, Greve JWM, et al. Revisional surgery after failed vertical banded gastroplasty: restoration of vertical banded gastroplasty or conversion to gastric bypass. Obes Surg 1998;8:21–8.CrossRefGoogle Scholar
  10. 10.
    Favretti F, Cadiere GB, Segato G, et al. Laparoscopic adjustable silicone gastric banding (Lap-Band®): how to avoid complications. Obes Surg 1997;7:352–8.CrossRefGoogle Scholar
  11. 11.
    Morino M, Toppino M, Garrone C. Disappointing long-term results of laparoscopic adjustable silicone gastric banding. Br J Surg 1997;84:868–9.CrossRefGoogle Scholar
  12. 12.
    Martin MJ, Mullenix PS, Steele SR, et al. A case match analysis of failed prior bariatric procedures converted to resectional bypass. Am J Surg 2004;187:666–71.CrossRefGoogle Scholar
  13. 13.
    Sugerman JH, Wolper JL. Failed gastroplasty for morbid obesity: revised gastroplasty versus Roux-en-Y gastric bypass. Am J Surg 1984;148:331–6.CrossRefGoogle Scholar
  14. 14.
    Buckwalter JA, Herbst CA, Khouri R. Morbid obesity. Second gastric operations for poor weight loss. Am Surg 1985;51:208–11.PubMedGoogle Scholar
  15. 15.
    Westling A, Ohrvall M, Gustavsson S. Roux-en-Y gastric bypass after previous unsuccessful gastric restrictive surgery. J Gastrointest Surg 2002;6:206–10.CrossRefGoogle Scholar
  16. 16.
    Suter M. Laparoscopic band repositioning for pouch dilatation/slippage after gastric banding: disappointing results. Obes Surg 2001;11:507–12.CrossRefGoogle Scholar
  17. 17.
    Weber M, Muller MK, Michel JM, et al. Laparoscopic Roux-en-Y gastric bypass, but not rebanding, should be proposed as rescue procedure for patients with failed laparoscopic gastric banding. Ann Surg 2003;238:827–34.CrossRefGoogle Scholar
  18. 18.
    Angrisani L, Lorenzo M, Borrelli V. Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 5-year results of a prospective randomized trial. Surg Obes Relat Dis 2007;3:127–32.CrossRefGoogle Scholar
  19. 19.
    Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004;351:2683–93.CrossRefGoogle Scholar
  20. 20.
    Demaria EJ. Bariatric surgery for morbid obesity. New Engl J Med 2007;356:2176–82.CrossRefGoogle Scholar
  21. 21.
    Jones KB. Revisional bariatric surgery-potentially safe and effective. Surg Obes Rel Dis 2005;1:599–603.CrossRefGoogle Scholar
  22. 22.
    Schwartz RW, Strodel WE, Simpson WS, et al. Gastric bypass revision: lessons learned from 920 cases. Surgery 1988;104:806–12.PubMedGoogle Scholar
  23. 23.
    Livingston EH, Ko CY. Assessing the relative contribution of individual risk factors on surgical outcome for gastric bypass surgery: a baseline probability analysis. J Surg Res 2002;105:48–52.CrossRefGoogle Scholar
  24. 24.
    Bolin RE. Gastric bypass. Surg Clin North Am 2001;81:1077–95.CrossRefGoogle Scholar
  25. 25.
    DeMaria EJ, Sugarman HJ, Kelum JM, et al. Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg 2002;235:640–7.CrossRefGoogle Scholar
  26. 26.
    Cottam DR, Mattar SG, Schauer PR. Laparoscopic era of operations for morbid obesity. Arch Surg 2003;138:367–75.CrossRefGoogle Scholar
  27. 27.
    Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg 2001;234:279–91.CrossRefGoogle Scholar
  28. 28.
    Westling A, Gustavsson S. Laparoscopic vs open Roux-en-Y gastric bypass: a prospective, randomized trial. Obes Surg 2001;11:284–92.CrossRefGoogle Scholar
  29. 29.
    Cohen R, Pinheiro JS, Correa JL, et al. Laparoscopic revisional bariatric surgery: myths and facts. Surg Endosc 2005;19:822–5.CrossRefGoogle Scholar
  30. 30.
    McCormick JT, Papasavas PK, Caushaj PF, et al. Laparoscopic revision of failed open bariatric procedures. Surg Endosc 2003;17:413–5.CrossRefGoogle Scholar
  31. 31.
    de Csepel J, Nahourali R, Gagner M. Laparoscopic gastric bypass as a reoperative bariatric surgery for failed open restrictive procedures. Surg Endosc 2001;15:393–7.CrossRefGoogle Scholar
  32. 32.
    Bessler M, Daud A, DiGiorgi MF. Adjustable gastric banding as a revisional bariatric procedure after failed gastric bypass. Obes Surg 2005;15:1443–8.CrossRefGoogle Scholar
  33. 33.
    Kyzer S, Raziel A, Landau O, et al. Use of adjustable silicone gastric banding for revision of failed gastric bariatric operations. Obes Surg 2001;11:66–9.CrossRefGoogle Scholar
  34. 34.
    Schouten R, van Dielen FMH, van Gemert WG, et al. Conversion of vertical banded gastroplasty to Roux-en-Y gastric bypass results in restoration of the positive effect on weight loss and co-morbidities: evaluation of 101 patients. Obes Surg 2007;17:622–30.CrossRefGoogle Scholar
  35. 35.
    Suter M, Paroz A, Calmes JM, et al. European experience with laparoscopic Roux-en-Y gastric bypass in 486 obese patients. Br J Surg 2006;93:726–32.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • C. S. H. Lim
    • 1
    Email author
  • V. Liew
    • 2
  • M. L. Talbot
    • 3
  • J. O. Jorgensen
    • 3
  • K. W. Loi
    • 3
  1. 1.Department of Upper Gastrointestinal, Advanced Laparoscopic and Bariatric SurgerySt George HospitalKogarahAustralia
  2. 2.Upper Gastrointestinal/Hepatopancreatobiliary SurgeryGold Coast HospitalSouthportAustralia
  3. 3.Department of Upper Gastrointestinal, Advanced Laparoscopic and Bariatric SurgerySt George Private HospitalSydneyAustralia

Personalised recommendations