Revisional Bariatric Surgery for Weight Regain and Refractory Complications in a Single MBSAQIP Accredited Center: What Are We Dealing with?

BACKGROUND

Revisional surgery is the fastest growing area in bariatric surgery, constituting 13.6% of all procedures performed as of 2015. This reflects a rising need to treat adverse sequelae of primary bariatric procedures. Despite the increase in revisions, their safety and efficacy remain controversial. The objective of this study is to review the experience of revisional bariatric surgery in our center and the relevant literature to date.

METHODS

We performed an IRB-approved review of prospectively collected data from all patients undergoing revisional bariatric surgery between 2012 and 2015. Due to patient heterogeneity, we divided subjects into two groups: patients who underwent surgery for weight regain (WR) and those who underwent surgery to address refractory complications (RC) related to their primary bariatric procedure. Demographics, indications, and outcomes of each group were compared using Fisher's exact test, Mann-Whitney rank sums, and chi-square tests. We also divided WR patients based on their primary index procedure and analyzed them separately.

RESULTS

We performed a total of 84 procedures over 4 years. Forty-three patients (53.6%) underwent surgery for WR and 41 (46.4%) for RC. The variety and distribution of primary bariatric procedures were gastric band (40%), gastric bypass (35.4%), sleeve gastrectomy (22%), and vertical banded gastroplasty (3.7%). The indications for revisional surgery due to RC included gastroesophageal reflux disease, internal hernia, gastro-gastric fistula, marginal ulcer, excess weight loss, and pain. Overall complication rate was 14.3% (three early, nine late); there was one leak. Five patients required a reoperation (5.9%; two early, three late). Excess weight loss varied from 31.5-79.1% 12 months after revision.

CONCLUSION

Patients presenting to our center for revisional surgery do so for either WR or RC, most commonly following gastric banding. Revisional bariatric surgery can be performed with low complication rates and with acceptable 12-month weight loss, though not with the same safety as primary procedures.