Abstract
Background
Laparoscopic revisional bariatric surgery (RBS) is increasingly common. A tailored decision-making process is advocated. In this retrospective study, we reviewed the RBS experience of a single center, analyzing perioperative complications to provide insight into management options and midterm outcomes.
Methods
Records from November 2011 to March 2015 were reviewed from prospectively maintained database. Six hundred eighteen patients underwent laparoscopic bariatric procedures; of these, 81 (13.1 %) underwent RBS. Patients with a minimum follow-up of 6 months (n = 77) were evaluated. Fifty-nine underwent revised laparoscopic sleeve gastrectomy, and 18 underwent revised Roux-en-Y gastric bypass. Indications for RBS were inadequate weight loss or weight regain in 42 cases (54.5 %) and gastroesophageal reflux disease (GERD), procedure-related complications, or technical failure in 35 cases (45.5 %).
Results
There were no deaths or conversions to open surgery. After a mean follow-up of 22 months, body mass index (BMI) decreased from 40.9 ± 6.7 to 31.9 ± 4.8 kg/m2, mean % excess weight loss (%EWL) was 58 ± 24.3 %, and 55.3 % of patients had resolution of comorbidities. Eight major complications (10.4 %) occurred: five leaks and three intra-abdominal hematomas. Non-surgical management succeeded in 50 % of complications.
Conclusions
This study confirms that RBS is challenging; a complication rate of 10 % is expected. Major surgery can be avoided when devoted endoscopists and radiologists are available. Intensive follow-up after complications allows early diagnosis and treatment of unfavorable sequelae. RBS induced a mean %EWL of 58 % at 2 years and resolution of comorbidities in 50 % of cases. However, the durability of these effects remains questionable.
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References
Radtka III JF, Puleo FJ, Wang L, et al. Revisional bariatric surgery: who, what, where, and when? Surg Obes Relat Dis. 2010;6(6):635–42.
Kellogg TA. Revisional bariatric surgery. Surg Clin N Am. 2011;91(6):1353–71.
Brolin RE, Cody RP. Weight loss outcome of revisional bariatric operations varies according to the primary procedure. Ann Surg. 2008;248(2):227–32.
Brethauer SA, Kothari S, Sudan R, et al. Systematic review on reoperative bariatric surgery: American Society for Metabolic and Bariatric Surgery Revision Task Force. Surg Obes Relat Dis. 2014;10(5):952–72.
Gagner M, Gumbs AA. Gastric banding: conversion to sleeve, bypass, or DS. Surg Endosc. 2007;21(11):1931–5.
Marsk R, Jonas E, Gartzios H, et al. High revision rates after laparoscopic vertical banded gastroplasty. Surg Obes Relat Dis. 2009;5(1):94–8.
Ruscio S, Abdelgawad M, Badiali D, et al. Simple versus reinforced cruroplasty in patients submitted to concomitant laparoscopic sleeve gastrectomy: prospective evaluation in a bariatric center of excellence. Surg Endosc. 2015 Oct 1.
Vij A, Malapan K, Tsai CC, et al. Worthy or not? Six-year experience of revisional bariatric surgery from an Asian center of excellence. Surg Obes Relat Dis. 2015;11(3):612–20.
Iossa A, Fiocca F, Corona M, et al. Severe events related to use of stents in case of bariatric complications. CRSLS. 2014. doi:10.4293/CRSLS.2014.002234.
Nesset EM, Kendrick ML, Houghton SG, et al. A two-decade spectrum of revisional bariatric surgery at a tertiary referral center. Surgery for obesity and related diseases. Off J Am Soc Bariatric Surg. 2007;3(1):25–30.
Spyropoulos C, Kehagias I, Panagiotopoulos S, et al. Revisional bariatric surgery: 13-year experience from a tertiary institution. Arch Surg. 2010;145(2):173–7.
Yimcharoen P, Heneghan HM, Tariq N, et al. Endoscopic stent management of leaks and anastomotic strictures after foregut surgery. Surg Obes Relat Dis. 2011;7(5):628–36.
Cohen R, Pinheiro JS, Correa JL, et al. Laparoscopic revisional bariatric surgery: myths and facts. Surg Endosc. 2005;19(6):822–5.
Gagner M, Gentileschi P, de Csepel J, et al. Laparoscopic reoperative bariatric surgery: experience from 27 consecutive patients. Obes Surg. 2002;12(2):254–60.
Khaitan L, Van Sickle K, Gonzalez R, et al. Laparoscopic revision of bariatric procedures: is it feasible? Am Surg. 2005;71(1):6–10.
Khoursheed MA, Al-Bader IA, Al-asfar FS, et al. Revision of failed bariatric procedures to Roux-en-Y gastric bypass (RYGB). Obes Surg. 2011;21(8):1157–60.
Morales MP, Wheeler AA, Ramaswamy A, et al. Laparoscopic revisional surgery after Roux-en-Y gastric bypass and sleeve gastrectomy. Surg Obes Relat Dis. 2010;6(5):485–90.
Sanchez H, Cabrera A, Cabrera K, et al. Laparoscopic Roux-en-Y gastric bypass as a revision procedure after restrictive bariatric surgery. Obes Surg. 2008;18(12):1539–43.
Van Dessel E, Hubens G, Ruppert M, et al. Roux-en-Y gastric bypass as a re-do procedure for failed restrictive gastric surgery. Surg Endosc. 2008;22(4):1014–8.
Zingg U, McQuinn A, DiValentino D, et al. Revisional vs. primary Roux-en-Y gastric bypass—a case-matched analysis: less weight loss in revisions. Obes Surg. 2010;20(12):1627–32.
Shimizu H, Annaberdyev S, Motamarry I, et al. Revisional bariatric surgery for unsuccessful weight loss and complications. Obes Surg. 2013;23(11):1766–73.
Mahawar KK, Graham Y, Carr WR, et al. Revisional Roux-en-Y gastric bypass and sleeve gastrectomy: systematic review of comparative outcomes with respective primary procedures. Obes Surg. 2015;25(7):1271–80.
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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 26, 2144–2149 (2016). https://doi.org/10.1007/s11695-016-2071-x
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DOI: https://doi.org/10.1007/s11695-016-2071-x