Reoperative bariatric surgery for treatment of type 2 diabetes mellitus

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

“…Re‐operations that result in a new or different type of procedure are considered conversions, operations intended to resolve a complication or anatomic defect are called corrective procedures, and those that attempt to restore normal anatomy are called reversals. In addition to providing additional therapy for weight loss, re‐operative procedures have been shown to improve metabolic outcomes, specifically diabetes improvement and remission rates . In a study by Boru et al , among high‐volume bariatric surgery centers, only 3% of patients having an SG required re‐operations.…”

“…In a retrospective review of 1,273 patients, gastro‐gastric fistula occurred in 106% of those who had RYGB, generally due to gastric ischemia, fistula, or ulceration, and the majority presented with weight regain (80%) and pain (73.3%), where surgical revision was based on the anatomy: low fistula with gastric resection and gastrojejunal anastomotic revision, or high fistula with sleeve of the pouch and sleeve resection of the remnant stomach . Revisional surgery has also been performed to improve glycemic control in bariatric surgery patients with persistent T2D, with subsequent T2D improvement in 65 to 100% of patients .…”

Metabolic Surgery for the Treatment of Diabetes Mellitus Positioning of Leading Medical Associations in Mexico

“…Revisional MS has been extensively evaluated for weight recidivism, but since the bulk of information for diabetes recurrence is more limited, it was not included in our analysis. However, in order to provide complete information, it may be appropriate to mention a recent review of 30 articles [59], where Yan and colleagues found that 14 to 38% of patients who underwent revisional surgery presented persistent or recurrent diabetes. Conversion to a different procedure induced 20 to 80% additional excess weight loss, and diabetes improvement was documented in 65 to 100% of patients.…”

Metabolic and bariatric surgery: diabetes - a decade of discovery

“…We have a paucity of evidence regarding the role of revisional surgery in the treatment of T2DM [20,22] . In a review of multiple studies on revisional bariatric surgery, Yan et al [23] demonstrated that, in the majority of cases, reoperation has a positive effect on both improvement in diabetes and further weight reduction. Unfortunately, these observational studies were of rather low power, without investigation of diabetes being the primary end point [23] .…”

“…In a review of multiple studies on revisional bariatric surgery, Yan et al [23] demonstrated that, in the majority of cases, reoperation has a positive effect on both improvement in diabetes and further weight reduction. Unfortunately, these observational studies were of rather low power, without investigation of diabetes being the primary end point [23] . We have yet to evaluate with highpowered studies if the total years of diabetes improvement can be maximized with a stepwise approach.…”