The Anatomy of a Weight Recidivism and Revision Bariatric Surgical Clinic

Abstract

Abstract. Weight recidivism in bariatric surgery failure is multifactorial. It ranges from inappropriate patient selection for primary surgery to technical/anatomic issues related to the original surgery. Most bariatric surgeons and centers focus on primary bariatric surgery while weight recidivism and its complications are very much secondary concerns. Methods. We report on our initial experience having established a dedicated weight recidivism and revisional bariatric surgery clinic. A single surgeon, dedicated nursing, dieticians, and psychologist developed care maps, goals of care, nonsurgical candidate rules, and discharge planning strategies. Results. A single year audit (2012) of clinical activity revealed 137 patients, with a mean age 49 ± 10.1 years (6 years older on average than in our primary clinic), 75% of whom were women with BMI 47 ± 11.5. Over three quarters had undergone a vertical band gastroplasty while 15% had had a laparoscopic adjustable gastric band. Only 27% of those attending clinic required further surgery. As for primary surgery, the role of the obesity expert clinical psychologist was a key component to achieving successful revision outcomes. Conclusion. With an exponential rise in obesity and a concomitant major increase in bariatric surgery, an inevitable increase in revisional surgery is becoming a reality. Anticipating this increase in activity, Alberta Health Services, Alberta, Canada, has established a unique and dedicated clinic whose early results are promising.

A comparison of revisional and primary bariatric surgery

“…Patients were evaluated by a multidisciplinary team, including a nurse, dietician and psychologist, for red flags. 7 Surgical candidates were chosen based on the specific red flag system designed to identify patients who would be unlikely to benefit from further surgery. This conservative operating strategy mirrors that of the Centre of Excellence-accredited primary bariatric clinic.…”

“…6 A dedicated revision clinic was created to accommodate private and medical tourists who have little or no aftercare for the management of their nutrition and complications. 7 A multidisciplinary approach is modelled after the primary clinic, which includes nurses, dieticians, psychologists and physicians. A specific "red flag" system is used by each discipline to screen out patients who would be unlikely to succeed with revision surgery.…”

“…Red flag criteria include uncontrolled mental health issues, substance abuse, poor social supports, poor compliance and unrealistic goals. 7 The objective of this study was to review all 5 years of patients since the inception of the clinic and compare the outcomes, patient populations and complications between the revision clinic and the primary clinic.…”

The fate of laparoscopic adjustable gastric band removal

“…5 But safety is only 1 outcome parameter; appropriateness and chance of long-term success with a definitive revision bariatric procedure must also be factored in. Following band removal, patients may fit in 1 of 3 groups: (i) not interested in revision; (ii) interested in revision, but not a revision candidate owing to red flags; 20 and (iii) interested in revision and good revision candidate (Fig. 2).…”

Ileal interposition with sleeve gastrectomy for the treatment of type 2 diabetes

“…However, long term follow-up results of the patients who have undergone gastric banding or sleeve gastrectomy prove that the main problem reveals itself five years after surgery and one third of those patients require revision or additional surgical intervention. [9][10][11][12] Gastric band is entirely a restrictive operation. Sleeve gastrectomy is a restrictive procedure even though it causes changes in some digestive system hormones.…”