Worthy or not? Six-year experience of revisional bariatric surgery from an Asian center of excellence

Vij, Anirudh; Malapan, Kirubakaran; Tsai, Ching-Chung; Hung, Kuo-Chung; Chang, Po-Chi; Huang, Chih‐Kun

doi:10.1016/j.soard.2014.04.033

Cited by 10 publications

(5 citation statements)

References 28 publications

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“…The rate of complications seen in this study is significant but it is comparable to those of other studies of revisional bariatric surgery [14][15][16]. Therefore, as with other revisional surgery, it is recommended that they are performed at large volume bariatric centres to minimise the risk.…”

Section: Discussionsupporting

confidence: 78%

“…Indications for revision surgery fall broadly into two camps: operation failure-predominantly patients who have experienced suboptimal weight loss or weight regain-and intractable symptoms, such as abdominal pain or vomiting. Such revision surgery is successful for some, but many patients will experience no benefit [14,15]. Candy cane or hockey stick after RYGB refers to an excessively long-blind afferent Roux limb at the gastrojejunostomy site.…”

Section: Discussionmentioning

confidence: 99%

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Candy cane revision after Roux-en-Y gastric bypass

et al. 2019

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Background An excessively long-blind end of the alimentary limb following a Roux-en-Y gastric bypass (RYGB), known as a 'candy cane' (CC), may cause symptoms including abdominal pain, regurgitation and vomiting. Very few studies have examined the efficacy of surgical resection of the CC. Objectives The aim of this study was to assess sensitivity of preoperative diagnostic tools for CC, as well as perioperative outcomes and symptom resolution after CC revision surgery. Setting High volume bariatric centre of excellence, United Kingdom. Methods Observational study of CC revisions from 2010 to 2017. Results Twenty-eight CC revision cases were identified (mean age 45 ± 9 years, female preponderance 9:1). Presenting symptoms were abdominal pain (86%), regurgitation/vomiting (43%), suboptimal weight loss (36%) and acid reflux (21%). Preoperative tests provided correct diagnosis in 63% of barium contrast swallows, 50% of upper gastrointestinal endoscopies and 29% computed tomographies. Patients presenting with pain had significantly higher CC size as compared with pain-free group (4.2 vs. 2 cm, p = 0.001). Perioperative complications occurred in 25% of cases. Complete or partial symptom resolution was documented in 73% of patients undergoing CC revision. Highest success rates were recorded in the regurgitation/ vomiting group (67%). Conclusion Surgical revision of CC is associated with good symptom resolution in the majority of patients, especially those presenting with regurgitation/vomiting. However, it carries certain risk of complications. CC diagnosis may frequently be missed; hence more than one diagnostic tool should be considered when investigating symptomatic patients after RYGB.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Candy cane revision after Roux-en-Y gastric bypass

et al. 2019

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“…In a prospective study, Himpens, et al reported that EWL was 53.3% 6 years after LSG [10]. Similarly, the results of 52 RS cases in 6 years, in which 96% of cases were laparoscopic procedures, EWL was 31.8% and the complication rate was 5.8% [11]. In our study, the PS and RS provide succcesful results in 12 months follow-up.…”

Section: Discussionsupporting

confidence: 72%

Is Revisional Bariatric Surgery Effective as Primary Surgery?

Seyit¹,

Halil²

2020

J Obes Weight-Loss Medic

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Background: To assess outcomes of laparoscopic sleeve gastrectomy (LSG) as primary surgery (PS) versus revisional surgery (RS) emphasizing weight loss, modification of comorbidities and complications. Methods: The study included randomly selected 350 PS patients for control group and 35 RS patients for study group. Prospectively-collected patient data were retrospectively reviewed. To measure the efficacy of the procedure, we calculated the excess weight loss percentage (EWL%). Effective weight loss was accepted as more than 50%. The changes in the status of the comorbid diseases, complications (leakage, bleeding and stenosis), weight loss, % excessive weight loss (EWL) and mortality were recorded. Results: Mean BMI before PS and RS were 47.59 ± 6.46 kg/m 2 and 44.52 ± 6.75 kg/m 2 (p = 0.07). The mean operation time was more in the RS group than in the PS group. The amount of weight given in the RS group was higher one year after surgery. Diabetes mellitus (DM) and Dyslipidemia (DL) remission rates were higher in revision surgery group. There was one mortality in RS group. Conclusions: To summarize the first to systematically discuss results of primary surgery versus revisional surgery from Turkey and we showed the evidence that revisional surgery can be successfully completed with acceptable postoperative morbidity risks comparing with primary surgery. There is a need for long-term follow-up outcomes of large randomized controlled studies to define the related to weight loss and delayed complications.

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“…[17][18][19][20][21] Revisional gastric bypass surgery is more technically challenging and has been shown to have a higher perioperative complication risk than gastric bypass surgery being performed as the initial procedure. [22][23][24][25] Unlike the early Australian experience, gastric bypass procedures have been favoured internationally since the introduction of bariatric surgery, particularly in the United States and Europe. As a result, international learning curve series have had far smaller proportions of revisional cases compared to Australian learning curves and in many instances, have intentionally excluded them.…”

Section: Introductionmentioning

confidence: 99%

“…While many patients are well served in the long‐term with LAGB procedures, 15,16 a large proportion ultimately undergo revision surgery for weight regain, complications or device intolerance 17–21 . Revisional gastric bypass surgery is more technically challenging and has been shown to have a higher perioperative complication risk than gastric bypass surgery being performed as the initial procedure 22–25 …”

Section: Introductionmentioning

confidence: 99%

Initial experience with laparoscopic gastric bypass in an Australian general foregut surgery unit

Zimmerman,

Bhimani,

Chan

et al. 2023

ANZ Journal of Surgery

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BackgroundLaparoscopic gastric bypass (LGB) is an increasingly utilized approach to bariatric surgery in Australia. A high proportion of those procedures are revisional due to Australia's legacy of laparoscopic adjustable gastric banding (LAGB), which is not the case internationally. The aim of this study was to compare post‐operative outcomes in an Australian general foregut surgery unit against benchmarks published in the literature.MethodsThis is retrospective cohort study of morbidly obese patients undergoing primary or revisional laparoscopic Roux‐en‐Y gastric bypass (RYGB) or laparoscopic one anastomosis gastric bypass (OAGB) with the two senior authors between 5 May 2015 and 27 June 2019. Perioperative data for the unit's first 100 cases were collected prospectively, stored on a unit database and analysed. Post‐operative complications at 30 days, 90 days, mortality, length of hospital stay, and Defined Adverse Events were chosen as indicators of the perioperative outcome (as defined in the Monash Bariatric Surgery Registry).ResultsIn this cohort, 35% of procedures were RYGB and 65% were OAGB. The majority (58%) were revisional procedures. Most patients (74%) were female. The median age was 50. The comorbidity profile of the population was similar to those published internationally. The median hospital stay was 4 days. There was no mortality. Early complications occurred in 9% of patients, with 3% occurring late.ConclusionOutcomes of our first 100 cases are comparable with those recorded in the literature, notwithstanding a much higher proportion of revisional cases. LGB can be safely introduced in Australian general foregut surgery units by experienced laparoscopic surgeons.

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Worthy or not? Six-year experience of revisional bariatric surgery from an Asian center of excellence

Cited by 10 publications

References 28 publications

Candy cane revision after Roux-en-Y gastric bypass

Candy cane revision after Roux-en-Y gastric bypass

Is Revisional Bariatric Surgery Effective as Primary Surgery?

Initial experience with laparoscopic gastric bypass in an Australian general foregut surgery unit

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