Revisional vs. Primary Roux-en-Y Gastric Bypass—a Case-matched Analysis

Abstract

With the increase in bariatric procedures performed, revisional surgery is now required more frequently. Roux-en-Y gastric bypass (RYGB) is considered to be the gold standard revision procedure. However, data comparing revisional vs. primary RYGB is scarce, and no study has compared non-resectional primary and revisional RYGB in a matched control setting. Analysis of 61 revisional RYGB that were matched one to one with 61 primary RYGB was done. Matching criteria were preoperative body mass index, age, gender, comorbidities and choice of technique (laparoscopic vs. open). After matching, the groups did not differ significantly. Previous bariatric procedures were 13 gastric bands, 36 vertical banded gastroplasties, 10 RYGB and two sleeve gastrectomies. The indication for revisional surgery was insufficient weight loss in 55 and reflux in 6. Intraoperative and surgical morbidity was not different, but medical morbidity was significantly higher in revisional procedures (9.8% vs. 0%, p = 0.031). Patients undergoing revisional RYGB lost less weight in the first two postoperative years compared with patients with primary RYGB (1 month, 14.9% vs. 29.7%, p = 0.004; 3 months, 27.4% vs. 51.9%, p = 0.002; 6 months, 39.4 vs. 70.4%, p < 0.001; 12 months, 58.5% vs. 85.9%, p < 0.001; 24 months, 60.7% vs. 90.0%, p = 0.003). Although revisional RYGB is safe and effective, excess weight loss after revisional RYGB is significantly less than following primary RYGB surgery. Weight loss plateaus after 12 months follow-up.

Perioperative risk and complications of revisional bariatric surgery compared to primary Roux-en-Y gastric bypass

“…Similar to previously reported findings, our study showed that revisional bariatric surgery resulted in less percent weight loss when compared to primary RYGB [21]. The reason for this difference remains unclear, though some speculate that it is because the patients requiring revisional bariatric surgery for inadequate weight loss may have poor diet compliance that resulted in their need for secondary surgery.…”

Indications, safety, and feasibility of conversion of failed bariatric surgery to Roux-en-Y gastric bypass: a retrospective comparative study with primary laparoscopic Roux-en-Y gastric bypass

“…Mean length of stay was 6 days without mortality. Zingg et al [25] reported 61 conversions after AGB, VBG, RYGB, and GS without mortality. Fifty-two procedures were open, and there was an overall morbidity of 39.9% (24/61).…”

Reoperative Bariatric Surgery

“…BPD-DS has the lowest rate of reoperation among the bariatric procedures (5 %) [ 12 ]. This estimate is in contrast with the relatively high incidence of metabolic complications following BPD-DS.…”

“…He found significantly higher operating times, blood loss, and hospital stay in the reoperative group, but no differences in postoperative morbidity, resolution of comorbidities, mortality, and weight loss at 1 year. Zingg et al, in their analysis of 61 revisional RYGB matched with an equal number of primary RYGB, found that the rate of morbidity is signifi cantly higher, and the rate of weight loss in the fi rst 2 years is signifi cantly lower in the revisional group (EWL 58.5 ± 34.9 % versus 85.9 ± 26.2 %) [ 12 ]. Possible reasons accounting for this difference have been attributed to several factors.…”