Obesity Surgery

, Volume 20, Issue 12, pp 1627–1632 | Cite as

Revisional vs. Primary Roux-en-Y Gastric Bypass—a Case-matched Analysis

Less Weight Loss in Revisions
  • Urs Zingg
  • Alexander McQuinn
  • Dennis DiValentino
  • Steven Kinsey-Trotman
  • Philip Game
  • David Watson
Clinical Research


With the increase in bariatric procedures performed, revisional surgery is now required more frequently. Roux-en-Y gastric bypass (RYGB) is considered to be the gold standard revision procedure. However, data comparing revisional vs. primary RYGB is scarce, and no study has compared non-resectional primary and revisional RYGB in a matched control setting. Analysis of 61 revisional RYGB that were matched one to one with 61 primary RYGB was done. Matching criteria were preoperative body mass index, age, gender, comorbidities and choice of technique (laparoscopic vs. open). After matching, the groups did not differ significantly. Previous bariatric procedures were 13 gastric bands, 36 vertical banded gastroplasties, 10 RYGB and two sleeve gastrectomies. The indication for revisional surgery was insufficient weight loss in 55 and reflux in 6. Intraoperative and surgical morbidity was not different, but medical morbidity was significantly higher in revisional procedures (9.8% vs. 0%, p = 0.031). Patients undergoing revisional RYGB lost less weight in the first two postoperative years compared with patients with primary RYGB (1 month, 14.9% vs. 29.7%, p = 0.004; 3 months, 27.4% vs. 51.9%, p = 0.002; 6 months, 39.4 vs. 70.4%, p < 0.001; 12 months, 58.5% vs. 85.9%, p < 0.001; 24 months, 60.7% vs. 90.0%, p = 0.003). Although revisional RYGB is safe and effective, excess weight loss after revisional RYGB is significantly less than following primary RYGB surgery. Weight loss plateaus after 12 months follow-up.


Revisional surgery Roux-en-Y gastric bypass Weight loss Case-matched analysis 



The authors thank Dr. A. Jamieson for his help with the database and Prof. AJ Esterman, PhD, for his support with the statistical analysis.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295:1549–55.CrossRefPubMedGoogle Scholar
  2. 2.
    Brown VW, Fujioka K, Wilson PW, et al. Obesity: why be concerned? Am J Med. 2009;122:S4–11.CrossRefPubMedGoogle Scholar
  3. 3.
    Greenway FL, Ryan DH, Bray GA, et al. Pharmaceutical cost savings of treating obesity with weight loss medications. Obes Res. 1999;7:523–31.PubMedGoogle Scholar
  4. 4.
    National Institutes of Health. Consensus statement: gastrointestinal surgery for severe obesity. Nutrition. 1996;12:397–402.CrossRefGoogle Scholar
  5. 5.
    Sauerland S, Angrisani L, Belachew M, et al. Obesity surgery. Evidence-based guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc. 2005;19:200–21.CrossRefPubMedGoogle Scholar
  6. 6.
    DeMaria EJ, Sugerman HJ, Meador JG, et al. High failure rate after laparoscopic adjustable silicone gastric banding for treatment of morbid obesity. Ann Surg. 2001;233:809–18.CrossRefPubMedGoogle Scholar
  7. 7.
    Jones DB, Provost DA, DeMaria EJ, et al. Optimal management of the morbidly obese patient. SAGES appropriateness conference statement. Surg Endosc. 2004;18:1029–2037.CrossRefPubMedGoogle Scholar
  8. 8.
    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.CrossRefPubMedGoogle Scholar
  9. 9.
    Martin MJ, Mullenix PS, Steele SR, et al. A case-match analysis of failed prior bariatric procedures converted to resectional gastric bypass. Am J Surg. 2004;187:666–71.CrossRefPubMedGoogle Scholar
  10. 10.
    Iannelli A, Amato D, Addeo P, et al. Laparoscopic conversion of vertical banded gastroplasty (Mason MacLean) into Roux-en-Y gastric bypass. Obes Surg. 2008;18:43–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Cohne R, Pinheiro JS, Correa JL, et al. Laparoscopic revisional bariatric surgery. Myths and facts. Surg Endosc. 2005;19:822–5.CrossRefGoogle Scholar
  12. 12.
    Brolin RE, Cody RP. Weight loss outcome of revisional bariatric operations varies according to the primary procedure. Ann Surg. 2008;248:227–32.CrossRefPubMedGoogle Scholar
  13. 13.
    Coakley BA, Deveney CW, Spight DH, et al. Revisional bariatric surgery for failed restrictive procedures. Surg Obes Relat Dis. 2008;4:581–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Nesset EM, Kendrick ML, Houghton SG, et al. A two-decade spectrum of revisional bariatric surgery at a tertiary referral center. Surg Obes Relat Dis. 2007;3:25–30.CrossRefPubMedGoogle Scholar
  15. 15.
    van Wageningen B, Berends FJ, van Ramshorst B, et al. Revision of failed laparoscopic adjustable gastric banding to Roux-en-Y gastric bypass. Obes Surg. 2006;16:137–41.CrossRefPubMedGoogle Scholar
  16. 16.
    Mognol P, Chosidow D, Marmuse JP. Laparoscopic conversion of laparoscopic gastric banding to Roux-en-Y gastric bypass: a review of 70 patients. Obes Surg. 2004;14:1349–53.CrossRefPubMedGoogle Scholar
  17. 17.
    te Riele WW, Sze YK, Wiezer MJ, et al. Conversion of failed laparoscopic gastric banding to gastric bypass as safe and effective as primary gastric bypass in morbidly obese patients. Surg Obes Relat Dis. 2008;4:735–9.CrossRefGoogle Scholar
  18. 18.
    Topart P, Becouarn G, Ritz P. One-year weight loss after primary or revisional Roux-en-Y gastric bypass for failed adjustable gastric banding. Surg Obes Relat Dis. 2009;5:459–62.CrossRefPubMedGoogle Scholar
  19. 19.
    Owens BM, Owens ML, Hill CW. Effect of revisional bariatric surgery on weight loss and frequency of complications. Obes Surg. 1996;6:479–84.CrossRefPubMedGoogle Scholar
  20. 20.
    Ikramuddin S, Kellogg TA, Leslie DB. Laparoscopic conversion of vertical banded gastroplasty to a Roux-en-Y gastric bypass. Surg Endosc. 2007;21:1927–30.CrossRefPubMedGoogle Scholar
  21. 21.
    Durak E, Inabnet WB, Schrope B, et al. Incidence and management of enteric leaks after gastric bypass for morbid obesity during a 10-year period. Surg Obes Relat Dis. 2008;4:389–93.CrossRefPubMedGoogle Scholar
  22. 22.
    Roller JE, Provost DA. Revision of failed gastric restrictive operations to Roux-en-Y gastric bypass: impact of multiple prior bariatric operations on outcome. Obes Surg. 2006;16:865–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Chevallier JM, Paita M, Rodde-Dunet MH, et al. Predictive factors of outcome after gastric banding: a nationwide survey on the role of center activity and patients’ behaviour. Ann Surg. 2007;246:1034–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Burgmer R, Grigutsch K, Zipfel S, et al. The influence of eating behaviour and eating pathology on weight loss after gastric restriction operations. Obes Surg. 2005;15:684–91.CrossRefPubMedGoogle Scholar
  25. 25.
    Song, Fernstrom MH. Nutritional and psychological considerations after bariatric surgery. Aesthet Surg. 2008;28:195–9.CrossRefGoogle Scholar
  26. 26.
    Sarwer DB, Wadden TA, Moore RH, et al. Preoperative eating behaviour, postoperative dietary adherence, and weight loss after gastric bypass surgery. Surg Obes Relat Dis. 2008;4:640–6.CrossRefPubMedGoogle Scholar
  27. 27.
    Courcoulas A, Perry Y, Buenaventura P, et al. Comparing the outcomes after laparoscopic versus open gastric bypass: a matched paired analysis. Obes Surg. 2003;13:341–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Lujan JA, Frutos MD, Hernandez Q, et al. Laparoscopic versus open gastric bypass in the treatment of morbid obesity. A randomized prospective trial Ann Surg. 2004;239:433–7.Google Scholar
  29. 29.
    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;3:279–91.CrossRefGoogle Scholar
  30. 30.
    Gagner M, Gumbs AA. Gastric banding: conversion to sleeve, bypass, or DS. Surg Endosc. 2007;21:1931–5.CrossRefPubMedGoogle Scholar
  31. 31.
    Hallowell PT, Stellato TA, Yao DA, et al. Should bariatric revisional surgery be avoided secondary to increased morbidity and mortality. Am J Surg. 2009;197:391–6.CrossRefPubMedGoogle Scholar
  32. 32.
    Tucker O, Sucandy I, Szomstein S, et al. Revisional surgery after failed laparoscopic adjustable banding. Surg Obes Relat Dis. 2008;4:740–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2010

Authors and Affiliations

  • Urs Zingg
    • 1
  • Alexander McQuinn
    • 2
  • Dennis DiValentino
    • 2
  • Steven Kinsey-Trotman
    • 2
  • Philip Game
    • 1
  • David Watson
    • 2
  1. 1.Discipline of SurgeryUniversity of Adelaide, Royal Adelaide HospitalAdelaideAustralia
  2. 2.Flinders University Department of SurgeryFlinders Medical CentreBedford ParkAustralia

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