Morbid obesity. Second gastric operations for poor weight loss.

This is a report of a clinical investigation of weight gain occurring after initial good weight loss following an operation performed to treat morbid obesity. The reasons for weight gain or poor weight loss after the first operation, the indications for a second operation, and the effectiveness and complications of four different "second" operations were examined. Thirty-five patients who were weight loss failures, a subgroup of 556 patients upon whom one of five bariatric operations had been performed, provided the clinical material for this investigation. The findings indicate that technical and nontechnical patient factors are responsible for the failure of the initial bariatric operation. The most effective second operation to treat weight loss failures was gastric bypass with Roux-en-Y gastrojejunostomy (GBRY). More difficult to perform than when done as the first bariatric operation, GBRY when done as a second operation is associated with a higher complication rate.