title: Laparoscopic reoperative bariatric surgery: experience from 27 consecutive patients.
abstract: BACKGROUND
  10 to 25% of patients undergoing bariatric surgery will require a revision, either for unsatisfactory weight loss or for complications. Reoperation is associated with a higher morbidity and has traditionally been done in open fashion. The purpose of this study was to determine the safety and efficacy of reoperative surgery using a laparoscopic approach.
  
  
  METHODS
  A retrospective review of medical records over a 22-month period was conducted. 27 consecutive obesity surgery patients, who had undergone a laparoscopic revision, were identified. 26 of the 27 patients were women. The average age was 40.3 years (range 20 to 58 years) and average original preoperative body mass index (BMI) was 51.6 kg/m2 (range 42 to 66.5). The 27 primary bariatric operations consisted of vertical banded gastroplasty (12), gastric band placement (9) and gastric bypass (6). 17 of them were open procedures. After the primary surgery, the lowest average BMI was 37.6 kg/m2 (range 21 to 52), which increased to 42.7 kg/m2 (range 29 to 56) before reoperation. 24 of the 27 reoperations were indicated for insufficient weight loss. On average, revision was undertaken 52 months after the primary procedure (range 12 to 240 months).
  
  
  RESULTS
  24 of the 27 laparoscopic reoperations were conversions to a gastric bypass. A second reoperation was indicated for insufficient weight loss on four occasions. In one case, conversion to open surgery was required. The average operative time was 232 +/- 18.5 minutes (range 120 to 480) and length of hospital stay was 3.7 days (range 1 to 9). 22% percent of patients (6) experienced complications, including pneumothorax, gastric remnant dilation, gastrojejunostomy stenosis, port-site hernia and protein malnutrition. There was no mortality in the study. The average BMI was 35.9 kg/m2 (range 27 to 45.5) 8 months after surgery (range 1 to 22 months). Compared with a preoperative BMI of 42.7 kg/m2, the weight loss was statistically significant (p < 0.001).
  
  
  CONCLUSIONS
  Our results compare favorably with those reported for open reoperative bariatric surgery. A laparoscopic approach may be considered a feasible and safe alternative to an open operation.
authors.affiliation: Division of Laparoscopic Surgery, Mount Sinai School of Medicine, New York, NY, USA. michel.gagner@mountsinai.org
authors.forename: Michel
authors.initials: M
authors.lastname: Gagner
authors.forename: Paolo
authors.initials: P
authors.lastname: Gentileschi
authors.forename: John
authors.initials: J
authors.lastname: de Csepel
authors.forename: Subhash
authors.initials: S
authors.lastname: Kini
authors.forename: Emma
authors.initials: E
authors.lastname: Patterson
authors.forename: William B
authors.initials: WB
authors.lastname: Inabnet
authors.forename: Daniel
authors.initials: D
authors.lastname: Herron
authors.forename: Alfons
authors.initials: A
authors.lastname: Pomp
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D015391:Gastroplasty / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D012086:Reoperation / Q000009:adverse effects*; D012189:Retrospective Studies; D013997:Time Factors; D015431:Weight Loss