Revisional bariatric surgery for inadequate weight loss.

When behavioral or anatomic issues are not present, revisional surgery should be approached with a goal of treating malnutrition or enhancing excess weight loss. Unfortunately, no randomized controlled trials currently exist to help the practicing bariatric surgeon choose which revisional procedure to perform. A review of the available literature was undertaken and compared with our standard practices to see if any guidelines could be devised. At our institution, patients who have failed jejunal-ileal bypass are reversed in the setting of malnutrition and converted to a sleeve gastrectomy (SG) followed by duodenal switch (DS) as a second stage procedure in the setting of inadequate weight loss. After failed vertical banded gastroplasty (VBG), patients are converted to a Roux-en-Y gastric bypass (RYGBP). After failed adjustable gastric band (AGB) placement, we perform RYGBP. In the super-obese, we leave the band in place or convert to a DS with band removal. In patients with failed RYGBP, we convert our patients to DS, but placement of an AGB may be an acceptable option.