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How Far Can Our Expectations Go on Revisional Bariatric Surgery After Failed Adjustable Gastric Banding?

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Abstract

Purpose

Bariatric surgery has proven its effectiveness in the treatment of obesity and related comorbidities. However, several procedures may be required to treat this chronic disease and/or complications after bariatric surgery. The most frequent revisional surgeries performed after failed laparoscopic adjustable gastric banding (AGB) have been Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). The aim of this study is to compare medium-term outcomes of primary and revisional bariatric procedures.

Material and Methods

Single institution, matched case-control study of obese patients submitted to bariatric surgery, divided into four groups of 50 patients: (A) primary RYGB; (B) primary SG; (C) revisional Roux-en-Y gastric bypass (rRYGB) after failed laparoscopic AGB; (D) revisional sleeve gastrectomy (rSG) after failed laparoscopic AGB. Demographic variables, surgical procedures characteristics and complications, weight loss outcomes and resolution of comorbidities were compared.

Results

Mortality and morbidity were comparable between primary and revisional procedures. Weight loss outcomes were inferior in patients submitted to rRYGB when compared to those submitted to RYGB, with no significant differences found when comparing the other groups. Regarding comorbidities’ outcomes, only patients submitted to rSG had lower odds of comorbidities’ improvement. Patients submitted to rRYGB had an odd 7 times higher of comorbidities’ improvement than those submitted to rSG, independent of weight loss outcomes.

Conclusion

Revisional surgeries are safe procedures with adequate weight loss outcomes in this difficult set of patients. The choice of revisional procedure may not influence weight loss outcomes, but rRYGB seems to be a better option regarding comorbidities’ resolution.

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Acknowledgements

The authors would like to acknowledge all members of the CRI-O Group.

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Authors and Affiliations

  1. General Surgery Department, São João University Medical Center, Porto, Portugal

    André Pereira, Sara Rodrigues & Elisabete Barbosa

  2. Faculty of Medicine of University of Porto, São João University Medical Center, Porto, Portugal

    André Pereira, André Costa Pinho, Hugo Santos Sousa, Sara Rodrigues & Elisabete Barbosa

  3. Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Porto, Portugal

    André Costa Pinho, Hugo Santos Sousa, Eduardo Lima da Costa & John Preto

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Pereira, A., Pinho, A.C., Sousa, H.S. et al. How Far Can Our Expectations Go on Revisional Bariatric Surgery After Failed Adjustable Gastric Banding?. OBES SURG 31, 1603–1611 (2021). https://doi.org/10.1007/s11695-020-05167-y

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  • DOI: https://doi.org/10.1007/s11695-020-05167-y

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