title: Revisional Surgery for Failed Gastric Restrictive Procedures for Morbid Obesity.
abstract: As part of the Adelaide Obesity Surgery Study, we have reviewed all patients who have undergone revisional surgery. Of the 31 0 trial patients, 63 (20%) had revisions 1-69 (median 32) months following their original surgery-30% of all 105 gastrogastrostomy (GG) operations, 22% of 106 gastroplasty (GP) procedures, and 9% of 99 gastric bypasses (GB). Failure was due to stomal dilatation, 11% of all trial patients (71% of GG revisions), stomal stenosis, 6% (52% of GP revisions) and staple dehiscence, 4%. There was no mortality and a low hospital morbidity. Long-term success was only 23% (follow-up at least 3 years) and was achieved at considerable expense (3 reversals, 10 further revisions, 44 endoscopic procedures). Revisional surgery was successful in 45% of patients with stomal dilatation or dehiscence but in only 17% with stenosis. Overall, the most successful operation was revision of, or conversion to, gastric bypass (58% success rate), compared with gastroplasty (24%) and gastrogastrostomy (25%). Our long-term results following revisional surgery were disappointing, particularly for stenosis, and most failures followed revision to GG or GP. Roux-en-Y gastric bypass is the procedure of choice when considering revision.
authors.affiliation: Flinders Medical Centre, Royal Adelaide Hospital and The Queen Elizabeth Hospital, Adelaide, South Australia 5042 Australia.
authors.initials: R
authors.lastname: Hunter
authors.initials: JM
authors.lastname: Watts
authors.initials: R
authors.lastname: Dunstan
authors.initials: R
authors.lastname: Elmslie
authors.lastname: O' Brien P
authors.initials: A
authors.lastname: Slavotinek
authors.initials: J
authors.lastname: Walsh