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Outcome of Revisional Bariatric Surgery After Failed Sleeve Gastrectomy: a German Multicenter Study

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Abstract

Purpose

Sleeve gastrectomy (SG) is a common bariatric procedure that has been shown to be effective in both the short and long term, but it is not without risks, some of which necessitate revision or redo surgery (RS).

Materials and Methods

GBSR (German Bariatric Surgery Registry) data were evaluated in this multicenter analysis. Short-term results (1-year follow-up) of RS (Re-Sleeve gastrectomy, Roux-en-Y gastric bypass, RYGB, Omega-loop gastric bypass, OLGB, and duodenal switch, DS) following primary SG (n = 27939) were evaluated.

Results

Of PSG patients, 7.9% (n=2195) needed revision surgery. Nine hundred ninety-four patients underwent the aforementioned four surgical procedures (95 with R-SG, 665 with RYGB, 141 with OLGB, and 93 DS). Loss of follow-up within 1 year 52.44%. The most common reasons for RS were weight regain and/or a worsening of preexisting comorbidities. Regarding the operating time, R-SG was the shortest of the four procedures, and DS was the longest. In general, there were no significant advantages of one procedure over another in terms of complication incidence in these categories. However, certain complications were seen more often after R-SG and DS than with other redo procedures. There were significant differences in BMI reduction 1 year after surgery (RYGB: 5.9; DS: 10.1; OLGB: 9.1; and R-SG: 9.1; p<0.001). GERD, hypertension, and sleep apnea demonstrated statistically significant comorbidity remission. Diabetes exhibited non-significant differences.

Conclusion

According to the findings of our study, all revision surgeries effectively resolved comorbidities, promoted weight loss, and lowered BMI. Due to the disparate outcomes obtained by various methods, this study cannot recommend a particular redo method as the gold standard. Selecting a procedure should consider the redo surgery’s aims, the rationale for the revision, the patient’s current state, and their medical history.

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Acknowledgements

We would like to thank Mr. Martin Hukauf for his contributions to the statistical analysis of our data.

Author information

Authors and Affiliations

  1. Department of Surgery, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany

    Omar Thaher

  2. Department of Surgery, Elisabeth Klinikum Schmalkalden GmbH, Eichelbach 9, 98574, Schmalkalden, Germany

    Juan Fernando Mesa Daza

  3. Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany

    Roland S. Croner

  4. Department of General, Abdominal and Pediatric Surgery, Municipal Hospital, Straße des Friedens 122, 07548, Gera, Germany

    Christine Stroh

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  1. Omar Thaher
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  4. Christine Stroh
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Contributions

Omar Thaher and Juan Fernando Mesa Daza: study concept, literature review, manuscript writing. Christine Stroh and Roland Croner: study concept, preparation of data for statistical analysis, revision of manuscript, final approval of the manuscript. All authors contributed to the article and approved the submitted version.

Corresponding author

Correspondence to Christine Stroh.

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Ethics Approval

For this type of retrospective study, no formal consent was required. All data were gathered and analyzed in accordance with the privacy and ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare no competing interests.

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Key Points

1. Despite the advantages of sleeve gastrectomy (SG), insufficient weight loss, complications, or the persistence of comorbidities may necessitate revision surgery (7.9% documented in GBSR).

2. Depending on the revision procedure, revision surgery after a failed sleeve gastrectomy results in varying degrees of adequate weight loss and remission of comorbidities.

3. Although certain revision surgical procedures were linked with an increased complication rate, revision surgery appears to be a safe and effective therapeutic option following failed SG.

4. Patients deciding to undergo a bariatric revision surgery should be informed of the procedure’s intermediate and long-term risks.

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Thaher, O., Daza, J.F.M., Croner, R.S. et al. Outcome of Revisional Bariatric Surgery After Failed Sleeve Gastrectomy: a German Multicenter Study. OBES SURG 33, 3362–3372 (2023). https://doi.org/10.1007/s11695-023-06834-6

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  • DOI: https://doi.org/10.1007/s11695-023-06834-6

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