A comparison of revisional and primary bariatric surgery

Abstract

A comparison of revisional and primary bariatric surgeryBackground: Revisional surgery is an important component of addressing weight regain and complications following primary bariatric surgery. Owing to provincial need and the complexity of this patient population, a specialized multidisciplinary revision clinic was developed. We sought to characterize patients who undergo revision surgery and compare their outcomes with primary bariatric surgery clinic data. Methods:We completed a retrospective chart review of bariatric revision clinic patients compared with primary bariatric surgery patients from December 2009 to June 2014. Results:We reviewed the charts of 2769 primary bariatric clinic patients, 886 of whom had bariatric surgery, and 534 revision bariatric clinic patients, 83 of whom had revision surgery. Fewer revision clinic patients underwent surgery than primary clinic patients (22% v. 32%). The mean preoperative body mass index (BMI) was 44.7 ± 9.5 in revision patients compared with 45.7 ± 7.6 in primary bariatric surgery patients. Most revision patients had a prior vertical banded gastroplasty (VBG; 48%) or a laparoscopic adjustable gastric band (LAGB; 24%). Bands were removed in 36% of all LAGB patients presenting to clinic. Of the 134 procedures performed in the revision clinic, 83 were bariatric weight loss surgeries, and 51 were band removals. Revision clinic patients experienced a significant decrease in BMI (from 44.7 ± 9.5 to 33.8 ± 7.5, p < 0.001); their BMI at 12-month follow-up was similar to that of primary clinic patients (34.5 ± 7.0, p = 0.7). Complications were significantly more frequent in revision patients than primary patients (41% v. 15%, p < 0.001). Conclusion:A bariatric revision clinic manages a wide variety of complex patients distinct from those seen in a primary clinic. Operative candidates at the revision clinic are chosen based on favourable medical, anatomic and psychosocial factors, keeping in mind the resource constraints of a public health care system. Contexte : La chirurgie de révision est une intervention importante lors d'une reprise de poids ou lors de complications à la suite d'une chirurgie bariatrique primaire. Compte tenu des besoins provinciaux et de la complexité de cette population de patients, une clinique de révision multidisciplinaire spécialisée a été créée. Nous avons voulu caractériser les patients qui subissent une chirurgie de révision et comparer leurs résultats aux données de la clinique de chirurgie bariatrique primaire.Méthodes : Nous avons procédé à un examen rétrospectif des dossiers des patients de la clinique de révision bariatrique par rapport aux patients ayant subi une chirurgie bariatrique primaire entre décembre 2009 et juin 2014.Résultats : Nous avons examiné les dossiers de 2769 patients de la clinique bariatrique primaire, dont 886 avaient subi une chirurgie bariatrique, et 534 patients de la clinique de révision, dont 83 avaient subi une chirurgie de révision. Un moins grand nombre de patients de la clinique de révision ont subi une c...

Candy cane revision after Roux-en-Y gastric bypass

“…The rate of complications seen in this study is significant but it is comparable to those of other studies of revisional bariatric surgery [14][15][16]. Therefore, as with other revisional surgery, it is recommended that they are performed at large volume bariatric centres to minimise the risk.…”

Single Anastomosis Duodeno-ileostomy (SADI-S) Versus One Anastomosis Gastric Bypass (OAGB-MGB) as Revisional Procedures for Patients with Weight Recidivism After Sleeve Gastrectomy: a Comparative Analysis of Efficacy and Outcomes

“…More distal alimentary anastomosis done in the ileum during SADI-S compared to biliopancreatic diversion was actually causing higher weight loss due to a potent ileal brake mediated by an enhanced secretion of the Table 6 Comparative analysis of blood markers levels before and after revisional surgeries hormones peptide YY and glucagon-like peptide-1 which are associated with increased satiety and decreased food intake [7]. We could duplicate results of the previous studies in terms of weight loss and TWL% with a slight advantage of SADI-S over OAGB-MGB [7,[16][17][18][19][20][21][22]. Multiple studies reported EWL% as 70-80% with superiority for SADI procedure when compared to RYGB post-LSG [16,20,21].…”

Weight Loss Medications in Young Adults after Bariatric Surgery for Weight Regain or Inadequate Weight Loss: A Multi-Center Study

“…Unfortunately, co-morbidities often return with weight regain [ 5 , 6 ]. Surgical revisions may be attempted and have occasionally demonstrated improvements in obesity co-morbidities and weight loss, however, the risk of complications with revision procedures is significantly higher than with initial bariatric surgery [ 7 , 8 ]. While alternative surgical solutions for weight regain or inadequate weight loss exist, they do not prove to be sufficient long-term solutions [ 9 , 10 ].…”