Re-operations after Secondary Bariatric Surgery: a Systematic Review

Abstract

This paper reviews reoperations rates for short- and long-term complications following secondary bariatric procedures and need for further bariatric surgery. The search revealed 28 papers (1317 secondary cases) following at least 75 % of patients for 12 months or more. For adjustable gastric banding (AGB), rebanding had higher re-revisional rates than conversions into other procedures. Conversion of AGB to Roux-en-Y gastric bypass had the highest number of short- (10.7 %) and long-term (22.0 %) complications. We estimated 194 additional reoperations per 1000 patients having a secondary procedure, 8.8 % needing tertiary surgery. Despite being poorly reported, risks of reoperations for long-term complications and tertiary bariatric surgery are higher than usually reported risks of short-term complications and should be taken into account when choosing a secondary bariatric procedure and for economic evaluations.

Weight Change After Roux-en Y Gastric Bypass, Physical Activity and Eating Style: Is There a Relationship?

“…Bariatric surgery has proven to effectively treat morbid obesity and its comorbidities [1,2]. However, in 20-30% of the bariatric population insufficient weight loss (< 50% excess weight loss) or substantial weight regain is observed; both can lead to re-emerging of comorbidities and secondary and/ or tertiary bariatric procedures [3][4]. Behavioural factors can be modified and thereby reoperations could be avoided.…”

A qualitative investigation of the health economic impacts of bariatric surgery for obesity and implications for improved practice in health economics

“…The conceptualisation and construction phase of a health economic model could, for example, take into consideration that patients who are experiencing financial distress are at a higher risk of seeking ongoing bariatric surgical care (such as complications and reoperations) in the public health care system. In regard to potential complications and reoperations, recent evidence has found that complications and/or reoperations can cost as much as the primary procedure itself and that the estimated rates (particularly after secondary bariatric surgery) are higher than the usually reported risks (Campbell, Venn, et al, ; Kuzminov, Palmer, Wilkinson, Khatsiev, & Venn, ). In turn, some of these participants may allow their private health insurance to lapse if they experience even more financial hardship, increasing likelihood of future presentations for complications and reoperations through the public sector.…”

Revisão sistemática e metanálise do tratamento endoscópico do reganho de peso pós-derivação gástrica em Y-de-Roux

“…O reganho é um desfecho negativo complexo que geralmente ocorre em longo-prazo. A revisão cirúrgica não é padronizada e acarreta considerável morbimortalidade com piores desfechos quando comparada ao procedimento primário (Brethauer et al, 2014;Kuzminov et al, 2016). Assim, por ser menos invasivo, o tratamento endoscópico torna-se uma opção oportuna.…”

“…Por vezes, este é um doente que se apresenta tão ou mais obeso que no procedimento índice, mais velho, com mais tempo de doença e com o fator complicador do antecedente bariátrico que dificulta uma nova intervenção cirúrgica (Brethauer et al, 2014;Kuzminov et al, 2016). Estes fatores possivelmente explicam as maiores taxas de complicações da cirurgia bariátrica secundária.…”

“…Didaticamente, procedimentos bariátricos secundários podem ser divididos em três tipos (Brethauer et al, 2014;Kuzminov et al, 2016 Outra recente revisão sistemática desenvolvida por Brethauer et al (2014) mostrou que a maior parte dos procedimentos de conversão em paciente com DGYR são decorrentes do reganho de peso, e raramente por alterações metabólicas refratárias como desnutrição severa.…”