Revisional Bariatric Surgery

Abstract

Metabolic surgery is considered a valuable tool in treating obesity compared to the non-surgical approach. Its effectiveness is evident in the form of weight loss, eliminating obesity-related comorbidities, and improving quality of life. Hence, the rate of metabolic surgery conducted worldwide has risen dramatically, parallel to the increasing rates of obesity. Unfortunately, there are drawbacks to metabolic surgeries. Weight regain/insufficient weight loss is feared by the patient and bariatric surgeon and can occur with nonadherence to a healthy lifestyle and dietary habits. Long-term complications related to metabolic surgery are possible following any metabolic surgery (e.g., chronic reflux, malnutrition, and fistula). Revisional surgery is the most effective approach to combat these drawbacks, and therefore a bariatric surgeon should be familiar with it. This chapter will discuss the indication of revisional surgery, the preoperative workup, the surgical techniques, and the outcome of revisional surgery. The chapter will focus on the most commonly performed metabolic surgery, that is, laparoscopic adjustable gastric band, laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, and laparoscopic one anastomosis gastric bypass. By the end of this chapter, the reader will be able to: (1) Define metabolic surgery failure and indications of the revision. (2) Be able to approach the patient preoperatively and formulate a plan. (3) Be knowledgeable about the main operative steps. (4) Be aware of the predicted outcome of revisional surgery.