Multidisciplinary approach of non-responders after bariatric surgery reduces the indication for revisional surgery: a retrospective cohort study

Abstract

Background 20–30% of patients show a lack of response after bariatric surgery (BS). These non-responders may experience insufficient weight loss or significant weight regain. Based on previous research in our center, it has been identified that before the introduction of a multidisciplinary team (MDT), 68% of the non-responders underwent revisional surgery. This study describes the effect of an MDT on treatment strategy in non-responders after BS. Methods this retrospective study included non-responders that were reviewed in an MDT meeting. Patients were categorized as primary non- responders (1NR) or as secondary non-responders (2NR). Outcomes assessed were: I. MDT-based treatment (conservative versus operative), II. Weight loss, III. Complications after revisional surgery. Results a total of 104 patients were included (n = 15 1NR, n = 89 2NR). In 73 patients, lifestyle and/or behavioral changes were indicated. Only eleven patients (13%) were re-operated in which one complication occurred. Twenty patients did not show up at their appointment with the dietician, physical therapist and/or medical psychologist and were excluded from further analysis. Conservatively treated patients lost 2.1 kg < 12 months (SD = 7.29) and 0.8 kg < 24 months (SD = 5.08). Surgically treated patients lost 12.0 kg < 12 months (SD = 4.29) and 26.3 kg < 24 months (SD = 2.75). Conclusions the rate of revisional surgery decreased after the introduction of an MDT. An explanation for this could be that an MDT drives more patients towards a conservative treatment since it identifies modifiable lifestyle and/or behavioral factors contributing to non-response. Incorporation of an MDT may contribute to the selection of patients who might benefit from revisional surgery.