Obesity Surgery

, Volume 28, Issue 9, pp 2789–2795 | Cite as

Revisional Bariatric Surgery for Weight Regain and Refractory Complications in a Single MBSAQIP Accredited Center: What Are We Dealing with?

  • Jeffrey Qiu
  • Peter W. LundbergEmail author
  • T. Javier Birriel
  • Leonardo Claros
  • Jill Stoltzfus
  • Maher El Chaar
Original Contributions



Revisional surgery is the fastest growing area in bariatric surgery, constituting 13.6% of all procedures performed as of 2015. This reflects a rising need to treat adverse sequelae of primary bariatric procedures. Despite the increase in revisions, their safety and efficacy remain controversial. The objective of this study is to review the experience of revisional bariatric surgery in our center and the relevant literature to date.


We performed an IRB-approved review of prospectively collected data from all patients undergoing revisional bariatric surgery between 2012 and 2015. Due to patient heterogeneity, we divided subjects into two groups: patients who underwent surgery for weight regain (WR) and those who underwent surgery to address refractory complications (RC) related to their primary bariatric procedure. Demographics, indications, and outcomes of each group were compared using Fisher’s exact test, Mann-Whitney rank sums, and chi-square tests. We also divided WR patients based on their primary index procedure and analyzed them separately.


We performed a total of 84 procedures over 4 years. Forty-three patients (53.6%) underwent surgery for WR and 41 (46.4%) for RC. The variety and distribution of primary bariatric procedures were gastric band (40%), gastric bypass (35.4%), sleeve gastrectomy (22%), and vertical banded gastroplasty (3.7%). The indications for revisional surgery due to RC included gastroesophageal reflux disease, internal hernia, gastro-gastric fistula, marginal ulcer, excess weight loss, and pain. Overall complication rate was 14.3% (three early, nine late); there was one leak. Five patients required a reoperation (5.9%; two early, three late). Excess weight loss varied from 31.5–79.1% 12 months after revision.


Patients presenting to our center for revisional surgery do so for either WR or RC, most commonly following gastric banding. Revisional bariatric surgery can be performed with low complication rates and with acceptable 12-month weight loss, though not with the same safety as primary procedures.


Revision bariatric surgery Weight regain Refractory complications Conversion Gastric band Sleeve gastrectomy Gastric bypass 


Compliance with Ethical Standards

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this retrospective study, formal consent is not required.

Informed Consent Statement

As this study involved a retrospective review of a prospectively maintained, de-identified database, obtaining informed consent did not apply, and we obtained an exemption from informed consent by our center’s Institutional Review Board.

Statement of Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this retrospective study, formal consent is not required.


  1. 1.
    Ponce J, Demaria EJ, Nguyen NT, et al. American Society for Metabolic and Bariatric Surgery estimation of bariatric surgery procedures in 2015 and surgeon workforce in the United States. Surg for Obes and Rel Dis. 2016;12(9):1637–9.CrossRefGoogle Scholar
  2. 2.
    Estimate of Bariatric Surgery Numbers, 2011–2016. The American Society for Metabolic and Bariatric Surgery. Published Jul, 2016. Accessed Feb 23, 2018 from
  3. 3.
    Rosenthal RJ, Panel ISGE. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of > 12,000 cases. Surg for Obes and Rel Dis. 2012;8:8–19.CrossRefGoogle Scholar
  4. 4.
    Shimizu H, Annaberdyev S, Motamarry I, et al. Revisional bariatric surgery for unsuccessful weight loss and complications. Obes Surg. 2013;23(11):1766–73.CrossRefGoogle Scholar
  5. 5.
    Kellogg TA. Revisional bariatric surgery. Surg Clin North Am. 2011;91:1353–71.CrossRefGoogle Scholar
  6. 6.
    The American Society for Metabolic and Bariatric Surgery Revision Task Force, Brethauer SA, Kothari S, Sudan R, Williams B, English WJ, Brengman M, Kurian M, Hutter M, Stegemann L, Kallies K, Nguyen N, Ponce J, Morton JM. Systematic review on reoperative bariatric surgery. Surg for Obes and Rel Dis. 2014 (10):952–972Google Scholar
  7. 7.
    Reoch J, Mottillo S, Shimony A, et al. Safety of laparoscopic vs open bariatric surgery: a systematic review and meta-analysis. Arch Surg. 2011 Nov;146(11):1314–22.CrossRefGoogle Scholar
  8. 8.
    Fulton C, Sheppard C, Birch D, et al. A comparison of revisional and primary bariatric surgery. Can J Surg. 2017;60(3):205–11.CrossRefGoogle Scholar
  9. 9.
    Chaar ME, Stoltzfus J, Claros L, et al. Indications for revisions following 630 consecutive laparoscopic sleeve gastrectomy cases: experience in a single accredited center. J of Gastroint Surg. 2016;21(1):12–6.CrossRefGoogle Scholar
  10. 10.
    Brethauer SA, Kim J, El Chaar M, Papasavas P, Eisenberg D, Rogers A, Ballem N, Kligman M, Kothari S for the ASMBS clinical issues committee. Standardized outcomes reporting in metabolic and bariatric surgery Surg for Obes and Rel Dis 2015;11:489–506Google Scholar
  11. 11.
    Abdelgawad M, De Angelis F, Iossa A, et al. Management of complications and outcomes after revisional bariatric surgery: 3-year experience at a bariatric center of excellence. Obes Surg. 2016 Sep;26(9):2144–9.CrossRefGoogle Scholar
  12. 12.
    Radtka JF, Puleo FJ, Wang L, et al. Revisional bariatric surgery: who, what, where, and when? Surg for Obes and Rel Dis. 2010;6(6):635–42.CrossRefGoogle Scholar
  13. 13.
    Vij A, Malapan K, Tsai C, et al. Worthy or not? Six-year experience of revisional bariatric surgery from an Asian center of excellence. Surg for Obes and Rel Dis. 2015;11(3):612–20.CrossRefGoogle Scholar
  14. 14.
    El Chaar M, Stoltzfus J, Lundberg PW. Thirty-day outcomes of sleeve gastrectomy versus Roux-en-Y gastric bypass: first report based on metabolic and bariatric surgery accreditation and quality improvement program database. Surg Obes Relat Dis 2018; epub ahead of print Google Scholar
  15. 15.
    Gagner M, Gumbs AA. Gastric banding: conversion to sleeve, bypass, or DS. Surg Endosc. 2007;21:1931–5.CrossRefGoogle Scholar
  16. 16.
    Schouten R, van Dielen FM, 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
  17. 17.
    Carmeli I, Golomb I, Sadot E, et al. Laparoscopic conversion of sleeve gastrectomy to a biliopancreatic diversion with duodenal switch or a Roux-en-Y gastric bypass due to weight loss failure: our algorithm. Surg Obes Relat Dis. 2015 Jan-Feb;11(1):79–85.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Jeffrey Qiu
    • 1
  • Peter W. Lundberg
    • 2
    Email author
  • T. Javier Birriel
    • 2
  • Leonardo Claros
    • 2
  • Jill Stoltzfus
    • 2
  • Maher El Chaar
    • 1
    • 2
  1. 1.Temple University, Lewis Katz School of MedicinePhiladelphiaUSA
  2. 2.St Luke’s University Health NetworkBethlehemUSA

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