Skip to main content
Top
Published in: Surgical Endoscopy 7/2021

01-07-2021 | Obesity | 2020 SAGES Oral

Outcomes in revisional bariatric surgery: a high-volume single institution experience

Authors: Fareed Cheema, Michael Choi, Erin Moran-Atkin, Diego Camacho, Jenny Choi

Published in: Surgical Endoscopy | Issue 7/2021

Login to get access

Abstract

Background

This study aims to evaluate outcomes of adjustable gastric band (AGB) conversion to sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB), SG conversion to RYGB and RYGB revision procedures.

Methods

Patients undergoing secondary bariatric surgery between 2009 and 2017 were retrospectively identified from a prospective database. Primary outcomes were weight loss and improvement in comorbidities. For weight loss, percent of total body weight loss (%TWL) and percentage of excess BMI loss (%EBMIL) were included. Comorbidities included were hemoglobin A1C (HbA1C), cardiovascular risk (CV) and hypertension.

Results

266 Secondary bariatric procedures were analyzed. There were four Grade IIIb complications within 30 days. There was greater %EBMIL at 12 and 24 months in the AGB to RYGB group, and in %TWL at 24 months compared to AGB to SG group (p < 0.05). Only AGB to RYGB had significantly continued improvement in these two parameters at 24 months compared to at 6 months post-operatively—%EBMIL and %TWL tapered off in the other procedures. There was significantly lower CV risk in dyslipidemic patients at 24 months in the AGB to RYGB compared to the AGB to SG group. In the SG to RYGB patients, there was significant improvement in CV risk in dyslipidemic patients at 24 months compared to baseline. There was significant improvement in HbA1C in diabetics in AGB to RYGB patients at 6 and 12 months, in AGB to SG patients at 12 months, and in SG to RYGB patients at 12 and 24 months compared to baseline. In RYGB revision and SG to RYGB patients, there was a relative increase in the number of patients being normotensive at 24 months compared to baseline.

Conclusion

Secondary bariatric surgery is a complex and challenging procedure that may improve weight loss and cardiovascular risk for certain procedures but further studies will be necessary.

Graphic abstract

Literature
1.
go back to reference Elshaer M, Hamaoui K, Rezai P, Ahmed K, Mothojakan N, Al-Taan O (2019) Secondary bariatric procedures in a high-volume centre: prevalence, indications and outcomes. Obes Surg 29:2255–2262CrossRef Elshaer M, Hamaoui K, Rezai P, Ahmed K, Mothojakan N, Al-Taan O (2019) Secondary bariatric procedures in a high-volume centre: prevalence, indications and outcomes. Obes Surg 29:2255–2262CrossRef
2.
go back to reference Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric Surgery: a systematic review and meta-analysis. JAMA 292(14):1724–1728CrossRef Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric Surgery: a systematic review and meta-analysis. JAMA 292(14):1724–1728CrossRef
3.
go back to reference Chowbey PK, Soni V, Kantharia NS, Khullar R, Sharma A, Baijal M (2018) Laparoscopic Roux-en-Y gastric bypass: outcomes of a case-matched comparison of primary versus revisional surgery. J Minimal Access Surg 14(1):52–57CrossRef Chowbey PK, Soni V, Kantharia NS, Khullar R, Sharma A, Baijal M (2018) Laparoscopic Roux-en-Y gastric bypass: outcomes of a case-matched comparison of primary versus revisional surgery. J Minimal Access Surg 14(1):52–57CrossRef
4.
go back to reference Hallowell PT, Stellato TA, Yao DA, Robinson A, Schuster MM, Graf KN (2009) Should bariatric revisional surgery be avoided secondary to increased morbidity and mortality? Am J Surg 197(3):391–396CrossRef Hallowell PT, Stellato TA, Yao DA, Robinson A, Schuster MM, Graf KN (2009) Should bariatric revisional surgery be avoided secondary to increased morbidity and mortality? Am J Surg 197(3):391–396CrossRef
5.
go back to reference Landreneau JP, Strong AT, Rodriguez JH, Aleassa EM, Aminian A, Brethauer S, Schauer PR, Kroh MD (2018) Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass. Obes Surg 28(12):3843–3850CrossRef Landreneau JP, Strong AT, Rodriguez JH, Aleassa EM, Aminian A, Brethauer S, Schauer PR, Kroh MD (2018) Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass. Obes Surg 28(12):3843–3850CrossRef
6.
go back to reference Park JS, Han S (2019) Outcomes of primary sleeve gastrectomy versus conversion sleeve gastrectomy in morbidly obese patients. ASTR 96(5):259–265PubMed Park JS, Han S (2019) Outcomes of primary sleeve gastrectomy versus conversion sleeve gastrectomy in morbidly obese patients. ASTR 96(5):259–265PubMed
7.
go back to reference Dang JT (2016) Gastric band removal in revisional bariatric surgery, one-step versus two-step: a systematic review and meta-analysis. Obes Surg 26:866–873CrossRef Dang JT (2016) Gastric band removal in revisional bariatric surgery, one-step versus two-step: a systematic review and meta-analysis. Obes Surg 26:866–873CrossRef
8.
go back to reference Zhou R, Poirier J, Torquati A, Omotosho P (2019) Short-term outcomes of conversion of failed gastric banding to laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass: a meta-analysis. Obes Surg 29:420–425CrossRef Zhou R, Poirier J, Torquati A, Omotosho P (2019) Short-term outcomes of conversion of failed gastric banding to laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass: a meta-analysis. Obes Surg 29:420–425CrossRef
9.
go back to reference Janik MR, Rogula TG, Mustafa RR, Alhaj Saleh A, Khaitan L (2019) Safety of revision sleeve gastrectomy compared to Roux-en-Y gastric bypass after failed gastric banding: analysis of the MBSAQIP. Ann Surg 269(2):299–303CrossRef Janik MR, Rogula TG, Mustafa RR, Alhaj Saleh A, Khaitan L (2019) Safety of revision sleeve gastrectomy compared to Roux-en-Y gastric bypass after failed gastric banding: analysis of the MBSAQIP. Ann Surg 269(2):299–303CrossRef
10.
go back to reference Marin-Perez P, Betancourt A, Lomota M, Lo Menzo E, Szomstein S, Rosenthal R (2014) Outcomes after laparoscopic conversion of failed adjustable gastric banding to sleeve gastrectomy or Roux-en-Y gastric bypass. Br J Surg 101(3):254–260CrossRef Marin-Perez P, Betancourt A, Lomota M, Lo Menzo E, Szomstein S, Rosenthal R (2014) Outcomes after laparoscopic conversion of failed adjustable gastric banding to sleeve gastrectomy or Roux-en-Y gastric bypass. Br J Surg 101(3):254–260CrossRef
11.
go back to reference Abdemur A, Han SM, Lo Menzo E, Szomstein S, Rosenthal R (2016) Reasons and outcomes of conversion of laparoscopic sleeve gastrectomy to Roux-en-Y gastric bypass for nonresponders. SOARD 12(1):113–118 Abdemur A, Han SM, Lo Menzo E, Szomstein S, Rosenthal R (2016) Reasons and outcomes of conversion of laparoscopic sleeve gastrectomy to Roux-en-Y gastric bypass for nonresponders. SOARD 12(1):113–118
12.
go back to reference Cohen R, Pinheiro JS, Correa JL, Schiavon C (2005) Laparoscopic revisional bariatric surgery: myths and facts. Surg Endosc 19(6):822–825CrossRef Cohen R, Pinheiro JS, Correa JL, Schiavon C (2005) Laparoscopic revisional bariatric surgery: myths and facts. Surg Endosc 19(6):822–825CrossRef
13.
go back to reference Brethauer SA, Kim J, El-Chaar M, Papasavas P, Eisenberg D, Rogers A, Ballem N, Kligman M, Kothari S (2015) Standardized outcomes reporting in metabolic and bariatric surgery. SOARD 11(3):489–506 Brethauer SA, Kim J, El-Chaar M, Papasavas P, Eisenberg D, Rogers A, Ballem N, Kligman M, Kothari S (2015) Standardized outcomes reporting in metabolic and bariatric surgery. SOARD 11(3):489–506
14.
go back to reference Qiu J, Lundberg PW, Javier Birriel T, Claros L, Stoltzfus J, El-Chaar M (2018) Revisional bariatric surgery for weight regain and refractory complications in a single MBSAQIP accredited center: what are we dealing with? Obes Surg 28(9):2789–2795CrossRef Qiu J, Lundberg PW, Javier Birriel T, Claros L, Stoltzfus J, El-Chaar M (2018) Revisional bariatric surgery for weight regain and refractory complications in a single MBSAQIP accredited center: what are we dealing with? Obes Surg 28(9):2789–2795CrossRef
Metadata
Title
Outcomes in revisional bariatric surgery: a high-volume single institution experience
Authors
Fareed Cheema
Michael Choi
Erin Moran-Atkin
Diego Camacho
Jenny Choi
Publication date
01-07-2021
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 7/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-020-07855-3

Other articles of this Issue 7/2021

Surgical Endoscopy 7/2021 Go to the issue