Revisional bariatric surgery: a review of workup and management of common complications after bariatric surgery

Abstract

With the rising prevalence of obesity, there has been a steady rise in the number of bariatric surgeries performed worldwide. As expected, there has also been an increase in the number of revisional surgeries performed to manage acute and chronic postoperative complications. This review will discuss the major complications that can arise from the most common bariatric surgeries, their diagnosis, medical management, and potential revisional surgical options.

Decision-making Considerations in Revisional Bariatric Surgery

“…For those selected patients, especially patients with retained fundus or primary dilation on contrast study, resleeving is a viable option 54 . However, RYGB is the most common type of conversion surgery from primary SG for weight recurrence, insufficient weight loss, refractory GERD, stricture, leak, or a planned 2-stage approach to high-risk patients with high body mass index (BMI) 2,3,26,55–27 . SG conversion to RYGB for weight loss have been shown to have less %EWL compared with primary RYGB 13,44,58,59 .…”

“…SADI-S has been shown to have great short-term %EWL of 70% to 90% and resolution of T2DM of 47%% to 92.5% and 38.4%% to 75% at first and 5 years, respectively 90 . Common long-term complications include mostly nutritional issues such as malnutrition, hypocalcemia, vitamin D deficiency, secondary hyperparathyroidism, and iron deficiency 26 . SADI-S have been described in primary or revisional bariatric surgeries, usually from SG, AGB, or RYGB, for inadequate weight loss or weight recurrence; however, there has been limited data on revision surgeries after primary SADI-S 91,92 …”

“…Other considerations for workup include 24hour pH monitoring, barium swallow, and esophageal manometry for gastroesophageal reflux disease (GERD) after AGB and SG, or computed tomography scan for possible bleeding, leak, obstruction, or internal hernia. 26 Of note, there are many endoscopic interventions to manage bariatric surgery complications. 27 These include but are not limited to endoscopic sleeve gastroplasty as a primary procedure or resleeving for additional weight loss, stenting or endoscopic vacuum therapy for staple line or anastomotic leak, and endoscopic dilation for stricture.…”

“…It is also important to obtain the operative note from the primary surgery if possible, especially when there are numerous techniques to perform an RYGB or DS. Other considerations for workup include 24-hour pH monitoring, barium swallow, and esophageal manometry for gastroesophageal reflux disease (GERD) after AGB and SG, or computed tomography scan for possible bleeding, leak, obstruction, or internal hernia 26 …”

Surgical Management of Failed Roux-en-Y Gastric Bypass (RYGB) Reversal: A Case Study

“…Often, re-operative surgery consists of a reversal, revision, or conversion of the problematic bariatric operation. The decision to reverse, rather than revise or convert, has been steadily growing and is motivated by the perspective that revisions would also be problematic or persistent [1,[4][5][6]. However, there are no standardized guidelines for deciding on an RYGB reversal.…”