Skip to main content
SpringerLink
Log in

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

Less Weight Loss in Revisions

  • Clinical Research
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  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.

    Article  CAS  PubMed  Google Scholar 

  2. Brown VW, Fujioka K, Wilson PW, et al. Obesity: why be concerned? Am J Med. 2009;122:S4–11.

    Article  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  4. National Institutes of Health. Consensus statement: gastrointestinal surgery for severe obesity. Nutrition. 1996;12:397–402.

    Article  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  11. Cohne R, Pinheiro JS, Correa JL, et al. Laparoscopic revisional bariatric surgery. Myths and facts. Surg Endosc. 2005;19:822–5.

    Article  Google Scholar 

  12. Brolin RE, Cody RP. Weight loss outcome of revisional bariatric operations varies according to the primary procedure. Ann Surg. 2008;248:227–32.

    Article  PubMed  Google Scholar 

  13. Coakley BA, Deveney CW, Spight DH, et al. Revisional bariatric surgery for failed restrictive procedures. Surg Obes Relat Dis. 2008;4:581–6.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  25. Song, Fernstrom MH. Nutritional and psychological considerations after bariatric surgery. Aesthet Surg. 2008;28:195–9.

    Article  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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. 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.

    Article  Google Scholar 

  30. Gagner M, Gumbs AA. Gastric banding: conversion to sleeve, bypass, or DS. Surg Endosc. 2007;21:1931–5.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  32. Tucker O, Sucandy I, Szomstein S, et al. Revisional surgery after failed laparoscopic adjustable banding. Surg Obes Relat Dis. 2008;4:740–7.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

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.

Author information

Authors and Affiliations

  1. Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia

    Urs Zingg & Philip Game

  2. Flinders University Department of Surgery, Flinders Medical Centre, Bedford Park, Australia

    Alexander McQuinn, Dennis DiValentino, Steven Kinsey-Trotman & David Watson

Authors
  1. Urs Zingg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexander McQuinn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dennis DiValentino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Steven Kinsey-Trotman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Philip Game
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David Watson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Urs Zingg.

Additional information

No financial support.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zingg, U., McQuinn, A., DiValentino, D. et al. Revisional vs. Primary Roux-en-Y Gastric Bypass—a Case-matched Analysis. OBES SURG 20, 1627–1632 (2010). https://doi.org/10.1007/s11695-010-0214-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-010-0214-z

Keywords

Search

Navigation