Revisional bariatric surgery for chronic complications necessitates custom surgical solutions

Abstract

Bariatric surgery continues to grow as a treatment modality for obesity and weight-related comorbidities. The anatomic rearrangement can produce unique anatomic complications, as well as functional problems that are correctible with revisional operations. Understanding the unique subset of complications and the options available for correction can allow surgical solutions to be tailored to both the patient’s anatomy, and the symptoms or pathologies they are targeting. Revisional operations are becoming increasingly common, as the proportion of the general population who have previously undergone bariatric surgery continues to increase. Revisional bariatric operations are associated with an increased risk of complications and longer hospital stays, but in experienced centers can be performed safely, and often using minimally invasive approaches.

Massive enlargement of gastric pouch as a complication of gastrojejunal anastomotic stenosis following one anastomosis laparoscopic gastric bypass: A case report

“…American Society of Metabolic and Bariatric Surgeons (ASMBS) data, has reported that the proportion of revisional bariatric procedures performed in the United States increased from 6 % to 16.7 % between 2011 and 2019 [ 9 , 10 ].…”

“…Conversion to an open approach is frequently required, as surgeries are technically demanding due to severe adhesions and/or distorted anatomy. However, they can be executed safely in experienced centers, with mortality and morbidity similar to a primary approach [ 9 ].…”

Revision of restrictive bariatric procedures in elderly patients: results at a 5-year follow-up

“…Nowadays, Revisional Bariatric Surgery (RBS) compose 9-18% of all MBS [2][3][4]. The main indications for RBS are weight regain (WR) or insufficient weight loss (IWL)and 10-50% of patients with a previous restrictive procedure may require RBS [2,5].…”

Challenges of Revisional Metabolic and Bariatric Surgery: A Comprehensive Guide to Unraveling the Complexities and Solutions of Revisional Bariatric Procedures

“…Longer operative times and length of hospital stay, greater blood loss and risk for Intensive Care Unit stay, and more postoperative complications, readmissions, and reoperations have been reported for revisional procedures [ 18 ]. However, RMBS can be safely performed with acceptable outcomes in most cases [ 19 ], when performed by experienced bariatric surgeons in bariatric centers that have the resources to manage possible complications [ 20 ].…”