Is Revisional Gastric Bypass as Effective as Primary Gastric Bypass for Weight Loss and Improvement of Comorbidities?

Abstract

Background Revisional gastric bypass (R-RYGB) surgery is utilized for the management of inadequate weight loss or weight regain observed after some cases of bariatric surgeries. Data on the mid-term effectiveness of primary gastric bypass (P-RYGB) compared with R-RYGB (e.g., post sleeve gastrectomy/gastric banding) are controversial. Methods Retrospective chart review of all patients who received P-RYGB and R-RYGB (January 2011-June 2015) at our center. One hundred twenty patients who underwent P-RYGB and 34 R-RYGB who completed 18 months follow-up were included. We compared the effectiveness of P-RYGB with R-RYGB by assessing four anthropometric, two glycemic, and four lipid parameters, as well as the control of type 2 diabetes (T2DM), hypertension, dyslipidemia (remission, improvement, persistence, relapse, de novo), mortality and complications rates. Results A comparison of the effectiveness of P-RYGB with R-RYGB at 18 months revealed no significant differences in patients' age, gender, and preoperative BMI between groups. However, patients who received P-RYGB had lower mean weight (P = 0.001) and BMI (P < 0.001), reflected by a higher mean delta BMI (P = 0.02), total weight loss percentage (TWL%) (P < 0.0001) and excess weight loss percentage (EWL%) (P < 0.0001). No differences in glycemic parameters, lipid profiles, control of T2DM, hypertension, and dyslipidemia were observed. No death is reported and complication rates were comparable. Conclusions Although R-RYGB effectively addressed inadequate weight loss, weight regain, and recurrence of comorbidities after restrictive bariatric surgery, R-RYGB resulted in inferior weight loss compared with P-RYGB. Neither procedure differed in their clinical control of T2DM, hypertension, and dyslipidemia. Both procedures exhibited comparable complication rates.

Pharmacotherapies for Post‐Bariatric Weight Regain: Real‐World Comparative Outcomes

“…More research is needed to identify effective therapies and create evidence‐based guidelines for managing post‐bariatric weight regain because no antiobesity medication (AOM) is specifically approved for this population. Guidelines on pharmacotherapy for weight regain are needed as revisional bariatric surgeries are not as effective as primary procedures for weight loss (24,25) and expose patients to the risks of reoperation (25). This is important because AOMs are underutilized for people with obesity, with <2% of eligible patients receiving treatment (26).…”

Weight Regain and Insufficient Weight Loss After Bariatric Surgery: Definitions, Prevalence, Mechanisms, Predictors, Prevention and Management Strategies, and Knowledge Gaps—a Scoping Review

“…In comparison with WR, data on the prevalence of IWL is more limited [36], mostly assessed or stated as a "spin-off" when discussing the indication for revisional surgeries [17,39]. For instance, among 17 patients who underwent revision after LSG, 40% were indicated for conversion to biliopancreatic diversion/duodenal switch (BPD/DS) and RYGB because of IWL [17], and others found that 32% of patients underwent revisional RYGB because of IWL [35].…”

Missing Something? Comparisons of Effectiveness and Outcomes of Bariatric Surgery Procedures and Their Preferred Reporting: Refining the Evidence Base

“…Yet, the majority of studies seem not to collect or include data on these two important variables (PA and diet) that can potentially influence the gauging of effectiveness. This is regardless whether such studies are short-, medium-, or long-term comparisons of effectiveness between "variants" of one BS procedure, e.g., regular biliopancreatic limb RYGB vs. long biliopancreatic limb RYGB [26]; between two or more BS procedures, e.g., one-anastomosis gastric bypass vs. RYGB, or laparoscopic RYGB vs. laparoscopic SG [27,28]; between primary and revisional BS, e.g., primary vs. revisional gastric bypass [7]; or between BS procedure/s vs. no procedure (e.g., medical management) [29,30]. Interestingly, most studies appear not to have included, in their limitations, a note that postop PA and/or diet data were not collected and/or were not included in the analyses of comparisons of the BS outcomes [7,[26][27][28]31].…”

“…Comparisons of short-, medium-, or long-term effectiveness and outcomes of various bariatric surgery (BS) procedures, and comparisons of effectiveness and outcomes of BS vs no surgery usually encompass a range of variables. Important outcomes include safety (e.g., adverse events, operative mortality, perioperative complications, readmissions, long-term reoperation rates) or other relevant indicators (e.g., length of hospital stay) [1][2][3][4][5][6][7]. In addition to such variables, the indicators of effectiveness employed for comparisons frequently comprise three main components.…”

“…In addition to such variables, the indicators of effectiveness employed for comparisons frequently comprise three main components. These components include various anthropometric weight loss (WL) measures [e.g., WL, BMI, %BMI change, % excess BMI loss, percent total weight loss (%TWL), percent excess weight loss (%EWL), others)], a range of biochemical/ metabolic/clinical outcomes (FBG, HA1c, lipids, others), and improvements or worsening of comorbidities (e.g., type 2 diabetes mellitus) that are frequently gauged based on the post-BS levels of biochemical/clinical parameters [4,7,8]. However, the extent and quality of a patient's post-operative (post-op) physical activity (PA) and/or diet can both influence these anthropometric WL and biochemical/ clinical outcomes, directly (e.g., via WL) or indirectly (e.g., via improvements in insulin sensitivity, metabolic health).…”