Revisional bariatric surgery at a single institution

• Published in: The American journal of surgery Vol. 200; no. 5; pp. 651 - 654
• Main Authors: Fronza, Jeffrey Scott, M.D, Prystowsky, Jay B., M.D, Hungness, Eric S., M.D, Nagle, Alexander P., M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2010; Elsevier; Elsevier Limited
• Subjects: Abscesses; Adult; Banding; Bariatric surgery; Bariatric Surgery - adverse effects; Biological and medical sciences; Body Mass Index; Bypasses; Complications; Electronic health records; Female; Follow-Up Studies; Gastric bypass; Gastrointestinal surgery; General aspects; Humans; Ileal bypass; Illinois; Laparoscopy; Leaks; Male; Medical records; Medical sciences; Middle Aged; Morbidity; Obesity - surgery; Patients; Physicians; Reperfusion - utilization; Retrospective Studies; Revisional bariatric surgery; Roux-en-Y gastric bypass; Standard deviation; Stomach, duodenum, intestine, rectum, anus; Success; Surgeons; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; Variance analysis; Weight control; Weight loss; Illinois; Revisional bariatric surgery; Roux-en-Y gastric bypass; Bariatric surgery; Medicine; Stomach; Digestive system; Roux en Y loop; Institution
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2010.07.012

Abstract Background Bariatric surgery, although safe, can have long-term complications that require revision. Our series illustrates the spectrum of primary procedures, indications for surgery, and strategies for revision. Methods The study was a retrospective chart review. Sixty-three patients were identified. Of specific interest were complications and percentage of excess weight loss (EWL) during the follow-up period. Results Eighteen patients had a previous vertical banded gastroplasty (VBG), 26 had a Roux-en-Y gastric bypass (RYGB), 18 had a laparoscopic adjustable gastric banding (LAGB), and 1 had a jejunal-ileal bypass. All VBG patients were revised to RYGB. Seventeen RYGB patients were revised with RYGB. Eight LAGB patients were revised with RYGB. Eight RYGB patients had placement of LAGB. Two LAGB patients were revised with LAGB because of a slipped band. Eight LAGB patients had the band removed. The morbidity rate was 30% with a major morbidity rate of 11%. There were 2 leaks, neither required reoperation. Other major complications included 3 pneumonias, 2 reoperations, and 2 intra-abdominal abscesses. There were no mortalities. In the 15 patients who had conversion of VBG to RYGB, the mean EWL was 50%, with 60% of patients achieving more than 50% EWL. In the 10 patients who had revision of their RYGB, the mean EWL was 51%, with 60% of patients achieving more than 50%. In the 6 patients who had revision of LAGB to RYGB, the mean EWL was 39%, with 33% of patients achieving more than 50% EWL. In the 8 patients who had LAGB after RYGB the mean EWL was −2%, with 0% of patients achieving more than 50%. Conclusions Revisional surgery is effective, although complication rates are higher than primary bariatric surgery. The type of initial and revisional procedure affects EWL.