Ann Surg Treat Res.  2014 Jun;86(6):295-301. 10.4174/astr.2014.86.6.295.

Causes and outcomes of revisional bariatric surgery: initial experience at a single center

• Park JY
• Song D
• Kim YJ

• KMID: 2167106
• DOI: http://doi.org/10.4174/astr.2014.86.6.295

Abstract

PURPOSE
Bariatric surgery has become more prevalent owing to the worldwide obesity epidemic. With the growing number of bariatric procedures performed annually, the requirement for revisional and secondary operations is increasing accordingly. This study aimed to evaluate the initial experience of revisional bariatric surgery at a single specialized center.
METHODS
A retrospective review of the prospectively established database identified all patients who underwent revisional bariatric surgery between January 2008 and August 2013. The causes, surgical outcomes, and efficacy of the revisional surgeries were analyzed.
RESULTS
Twenty-two revisional surgeries were performed laparoscopically during the study period (13 laparoscopic adjustable gastric banding, 9 laparoscopic sleeve gastrectomy). The most common indication for revision was weight regain or insufficient weight loss (12/23, 52.2%), and Roux-en-Y gastric bypass (RYGB) was the most commonly performed secondary procedure (17/23, 73.9%, including four resectional RYGB procedures). Gastric pouch leak occurred in one patient following revisional RYGB, which required reoperation on the first postoperative day. The mean body mass index decreased from 35.9 to 28.8 kg/m2 at a mean follow-up period of 10 months after revision. The percent excess weight losses at 1, 3, 6, and 12 months postoperatively were 18.8%, 41.1%, 40.1%, and 47.4%, respectively.
CONCLUSION
Revisional bariatric surgery can be successfully performed via a laparoscopic approach with acceptable risk. Deliberate selection for the proper revisional procedure can efficiently manage undesirable results from the primary surgery.

Keyword

Morbid obesity; Bariatric surgery; Gastric bypass; Reoperation

MeSH Terms

Bariatric Surgery*
Body Mass Index
Follow-Up Studies
Gastric Bypass
Humans
Obesity
Obesity, Morbid
Prospective Studies
Reoperation
Retrospective Studies
Weight Loss

Figure

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  Fig. 1 Revisional procedures following failed laparoscopic adjustable gastric banding (LAGB), Roux-en-Y gastric bypass (RYGB), or sleeve gastrectomy (SG).

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  Fig. 2 Contrast upper gastrointestinal series of a patient who developed gastric stricture following laparoscopic sleeve gastrectomy. (A) AP view, (B) lateral view.

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