Skip to main content
SpringerLink
Log in

Revisional Bariatric/Metabolic Surgery: What Dictates Its Indications?

  • Lipid and Metabolic Effects of Gastrointestinal Surgery (R. Cohen, Section Editor)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Bariatric/metabolic surgery is currently the only effective long-term treatment for morbid obesity- and obesity-related diseases such as diabetes, heart disease, hypertension, obstructive sleep apnea, and dyslipidemia. In addition, bariatric/metabolic surgery has been shown to significantly reduce the incidence of diabetes and cancer and prolong life when compared to non-surgical therapies. However, as obesity is a chronic disease, recidivism of weight and comorbid conditions can occur. In addition, the surgical construct can lead to long-term consequences such as marginal ulceration, bowel obstruction, reflux, and nutritional deficiencies. Despite these drawbacks, prospective randomized controlled studies and long-term longitudinal population-based comparative studies greatly favor surgical intervention as opposed to traditional lifestyle, diet, and exercise programs. Revisional surgery can be quite complex and technically challenging and may offer the patient a wide variety of solutions for treatment of weight recidivism and complications after primary operations. Given the paucity of high quality published data, we have endeavored to provide indications for revisions after bariatric surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Mendis S, Global status report on noncommunicable diseases 2014. Chronic Disease—prevention and control. 2. Chronic Disease—epidemiology. 3.Chronic Disease—mortality. 4. Cost of Illness. 5. Delivery of Health Care. I. World Health Organization. ISBN 9789241564854. http://apps.who.int/iris/bitstream/10665/148114/1/9789241564854_eng.pdf

  2. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014;311(8):806–14. doi:10.1001/jama.2014.732.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Jensen MD, Ryan DH, Apovian CM, et al. AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014;63(25_PA). doi:10.1016/j.jacc.2013.11.004. Summarizes level of evidence of comorbidities reduction with weight loss.

  4. Whitlock G et al. Body-mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083–96. doi:10.1016/S0140-6736(09)60318-4.

    Article  PubMed  Google Scholar 

  5. Ricci C, Gaeta M, Rausa E, Macchitella Y, Bonavina L. Early impact of bariatric surgery on type II diabetes, hypertension, and hyperlipidemia: a systematic review, meta-analysis and meta-regression on 6,587 patients. Obes Surg. 2014;24(4):522–8.

    Article  PubMed  Google Scholar 

  6. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.

    Article  CAS  PubMed  Google Scholar 

  7. Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753–61. doi:10.1056/NEJMoa066603.

    Article  CAS  PubMed  Google Scholar 

  8. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.

    Article  CAS  PubMed  Google Scholar 

  9. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med. 2014;370(21):2002–13.

    Article  PubMed  Google Scholar 

  10. Sjöström L, Peltonen M, Jacobson P, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascularcomplications. JAMA. 2014;311(22):2297–304.

    Article  PubMed  Google Scholar 

  11. Ribaric G, Buchwald JN, McGlennon TW. Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. Obes Surg. 2014;24:437–55.

    Article  CAS  PubMed  Google Scholar 

  12. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015;386(9997):964–73. Randomized single center study, demonstrated: surgical therapy superior to conventional therapy.

  13. Rao WS, Shan CX, Zhang W, Jiang DZ, Qiu M. A meta-analysis of short-term outcomes of patients with type 2 diabetes mellitus and BMI ≤ 35 kg/m2 undergoing Roux-en-Y gastric bypass. World J Surg. 2015;39(1):223–30.

    Article  PubMed  Google Scholar 

  14. Aggarwal R, Harling L, Efthimiou E, Darzi A, Athanasiou T, Ashrafian H. The effects of bariatric surgery on cardiac structure and function: a systematic review of cardiac imaging outcomes. Obes Surg. 2015.

  15. Sjöström L, Gummesson A, Sjöström CD, et al. Swedish Obese Subjects Study. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Oncol. 2009;10(7):653–62. doi:10.1016/S1470-2045(09)70159-7.

    Article  PubMed  Google Scholar 

  16. Christou NV, Lieberman M, Sampalis F, et al. Bariatric surgery reduces cancer risk in morbidly obese patients. Surg Obes Relat Dis. 2008;4(6):691–5. doi:10.1016/j.soard.2008.08.025.

    Article  PubMed  Google Scholar 

  17. Zhou X, Yu J, Li L, Gloy VL, Nordmann A, Tiboni M, Li Y, Sun X. Effects of bariatric surgery on mortality, cardiovascular events, and cancer outcomes in obese patients: systematic review and meta-analysis. Obes Surg. 2016.

  18. Sampalis JS, Liberman M, Auger S et al. Impact of weight reduction surgery on health care costs in morbidly obese patients. Obes Sur. 14(7) pp. 939-47.

  19. Chang SH, Stoll CR, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg. 2014;149(3):275–87. Review articles Table 2 in results section summarizes—outcomes and complications of different bariatric surgeries.

  20. Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A, et al. Preoperative predictors of weight loss following bariatric surgery: systematic review. Obes Surg. 2012;22(1):70–89.

    Article  PubMed  Google Scholar 

  21. Cooper TC, Simmons EB, Webb K, Burns JL, Kushner RF. Trends in weight regain following Roux-en-Y gastric bypass (RYGB) bariatric surgery. Obes Surg. 2015;25(8):1474–81. Clarifies that one third of patients > 25% weight regain after initial bariatric surgery and majority of this group of patient had less weight loss in first year compared to others.

  22. Brethauer SA, Kothari S, Sudan R, et al. Review article: systematic review on reoperative bariatric surgery American Society for Metabolic and Bariatric Surgery Revision Task Force. Surg Obes Relat Dis. 2014;10:952–72.

    Article  PubMed  Google Scholar 

  23. Daigle CR, Chaudhry R, Boulse M, Corcelles R, Kroh M, Schauer PR, et al. Revisional bariatric surgery can improve refractory metabolic disease. Surg Obes Relat Dis. 2016;12:392–7.

    Article  PubMed  Google Scholar 

  24. Tamboli RA, Breitman I, Marks-Shulman PA, Jabbour K, Melvin W, Williams B, et al. Early weight regain after gastric bypass does not affect insulin sensitivity but is associated with elevated ghrelin. Obesity. 2014;22:1617–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Sudan R, Nguyen NT, Hutter MM, Brethauer SA, Ponce J, Morton JM. Morbidity, mortality, and weight loss outcomes after reoperative bariatric surgery in the USA. J Gastrointest Surg. 2015;19(1):171–8. Summarizes outcomes between primary versus revisional versus conversion bariatric surgeries.

  26. Shimizu H, Annaberdyev S, Motamarry I, Kroh M, Schauer PR, Brethauer SA. Revisional bariatric surgery for unsuccessful weight loss and complications. Obes Surg. 2013;23(11):1766–73.

    Article  PubMed  Google Scholar 

  27. Himpens J, Coromina L, Verbrugghe A, Cadière GB. Outcomes of revisional procedures for insufficient weight loss or weight regain after Roux-en-Y gastric bypass. Obes Surg. 2012;22(11):1746–54. doi:10.1007/s11695-012-0728-7.

  28. Edholm D, Ottosson J, Sundbom M. Importance of pouch size in laparoscopic Roux-en-Y gastric bypass: a cohort study of 14,168 patients. Surg Endosc. 2015.

  29. Al-Bader I, Khoursheed M, Al Sharaf K, Mouzannar DA, Ashraf A, Fingerhut A. Revisional laparoscopic gastric pouch resizing for inadequate weight loss after Roux-en-Y gastric bypass. Obes Surg. 2015;25(7):1103–8. doi:10.1007/s11695-015-1579-9.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Patel S, Szomstein S, Rosenthal RJ. Reasons and outcomes of reoperative bariatric surgery for failed and complicated procedures (excluding adjustable gastric banding). Obes Surg. 2011;21(8):1209–19. doi:10.1007/s11695-010-0234-8.

    Article  PubMed  Google Scholar 

  31. Gupta RV, Chamany T, Makam R. Does length of common limb influence remission of diabetes? Short-term results. J Minim Access Surg. 2016;12(1):54–7.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Mahawar KK, Kumar P, Parmar C, Graham Y, et al. Small bowel limb lengths and Roux-en-Y gastric bypass: a systematic review. Obes Surg. 2016;26(3):660–71.

    Article  PubMed  Google Scholar 

  33. Marin-Perez P, Betancourt A, Lamota M, Lo Menzo E, Szomstein S, Rosenthal R. Outcomes after laparoscopic conversion of failed adjustable gastric banding to sleeve gastrectomy or Roux-en-Y gastric bypass. Br J Surg. 2014;101(3):254–60. doi:10.1002/bjs.9344.

    Article  CAS  PubMed  Google Scholar 

  34. Dang JT, Switzer NJ, Wu J et al. Gastric band removal in revisional bariatric surgery, one-step versus two-step: a systematic review and meta-analysis. Obes Surg. 2016. Recent systematic review article again supports comparable outcomes between one step and two step procedure for gastric band removal to gastric bypass.

  35. Elnahas A, Graybiel K, Farrokhyar F, Gmora S, Anvari M, Hong D. Revisional surgery after failed laparoscopic adjustable gastric banding: a systematic review. Surg Endosc. 2013;27(3):740–5.

    Article  PubMed  Google Scholar 

  36. Stefanidis D, Malireddy K, Kuwada T, Phillips R, Zoog E, Gersin KS. Revisional bariatric surgery: perioperative morbidity is determined by type of procedure. Surg Endosc. 2013;27(12):4504–10.

    Article  CAS  PubMed  Google Scholar 

  37. Kassir R, Blanc P, Gugenheim J, Amor IB, Debs T, TIffet O. Laparoscopic conversion of vertical banded gastroplasty into Roux-en-Y gastric bypass. Obes Surg. 2016;26(2):474–5. Good discussion on single institution experience of conversion for failed sleeve gastrectomy to Roux En Y gastric bypass.

  38. Facchiano E, Leuratti L, Veltri M, Lucchese M. Laparoscopic conversion of one anastomosis gastric bypass to Roux-en-Y Gastric bypass for chronic bile reflux. Obes Surg. 2016;26(3):701–3.

    Article  PubMed  Google Scholar 

  39. Chen CY, Lee WJ, Lee HM, Chen JC, Ser KH, Lee YC, Chen SC. Laparoscopic conversion of gastric bypass complication to sleeve gastrectomy: technique and early results. Obes Surg. 2016.

  40. Zaveri H, Dallal R M, Cottam D et al. Indications and operative outcomes of gastric bypass reversal. Obes Surg. 2016. Multicenter study looking at outcomes of gastric bypass reversal and various indications for reversal.

  41. Moon RC, Frommelt A, Teixeira AF, Jawad MA. Indications and outcomes of reversal of roux-en-Y gastric bypass. Surg Obes Relat Dis. 2015;11(4):821–6.

    Article  PubMed  Google Scholar 

  42. Campos GM, Ziemelis M, Paparodis R, Ahmed M, Davis DB. Laparoscopic reversal of Roux-en-Y gastric bypass: technique and utility for treatment of endocrine complications. Surg Obes Relat Dis. 2014;10(1):36–43.

    Article  PubMed  Google Scholar 

  43. Akusoba I, Birriel TJ, El Chaar M. Management of excessive weight loss following laparoscopic Roux-en-Y gastric bypass: clinical algorithm and surgical techniques. Obes Surg. 2016;26:5–11.

    Article  PubMed  Google Scholar 

  44. Zaveri H, Dallal RM, Cottam D et al. Indications and operative outcomes of gastric bypass reversal. Obes Surg. 2016.

  45. Vilallonga R, van de Vrande S, Himpens J. Laparoscopic reversal of Roux-en-Y gastric bypass into normal anatomy with or without sleeve gastrectomy. Surg Endosc. 2013;27(12):4640–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. UCSF-Fresno Medical Education Program, Fresno, CA, USA

    Pearl Ma, Subhash Reddy & Kelvin D. Higa

Authors
  1. Pearl Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Subhash Reddy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kelvin D. Higa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pearl Ma.

Ethics declarations

Conflict of Interest

Pearl Ma, Subhash Reddy, and Kelvin D. Higa declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Lipid and Metabolic Effects of Gastrointestinal Surgery

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ma, P., Reddy, S. & Higa, K.D. Revisional Bariatric/Metabolic Surgery: What Dictates Its Indications?. Curr Atheroscler Rep 18, 42 (2016). https://doi.org/10.1007/s11883-016-0592-3

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11883-016-0592-3

Keywords

Search

Navigation