title: A case-match analysis of failed prior bariatric procedures converted to resectional gastric bypass.
abstract: BACKGROUND
  Failure to lose weight or intractable symptoms after bariatric surgery presents a complex diagnostic and management challenge. The outcome of a standardized surgical approach to this problem has not been well described. Conversion of failed bariatric procedures to a resectional gastric bypass (RGB) can achieve symptomatic relief and acceptable weight loss.
  
  
  METHODS
  We reviewed all patients in a prospectively maintained database who underwent reoperative bariatric surgery over a 4-year period. Reoperative patients (RO) were case-matched (by age, body mass index, and comorbidities) in a 1:2 ratio with control patients undergoing an initial bariatric procedure (IN).
  
  
  RESULTS
  Twenty-seven reoperative patients and 54 case-matched control patients were identified. Mean body mass index was 42 in the RO group versus 45 in the IN group (P = not significant). Indications for conversion were weight gain (89%), dysphagia/emesis (30%), esophagitis (19%), and marginal ulcer (7%). All patients in both groups underwent RGB (subtotal gastrectomy with Roux-Y gastrojejunostomy). Compared with IN patients, the RO patients had significantly longer operative times (420 versus 268 minutes), greater blood loss (650 versus 315 cc), longer time to oral intake (3.1 versus 2.2 days), and longer hospital stays (6.5 versus 4.7 days), all P <0.01. There were no deaths or anastomotic leaks in either group. Excess body weight lost at 6 months was 46% for RO versus 54% for IN (P = 0.02). One-year excess weight lost was 71% for RO versus 77% for IN (P = not significant). All RO patients achieved symptomatic relief, and no patient required further bariatric revision. There was significant improvement in weight-related comorbidity in each group.
  
  
  CONCLUSIONS
  Conversion of failed bariatric procedures to RGB, although technically demanding, resulted in relief of presenting symptoms, significant 6-month and 1-year weight loss, and improvement of major comorbidities. Conversion of failed bariatric procedures to resectional gastric bypass can achieve results comparable with those of patients undergoing an initial bariatric procedure.
authors.affiliation: Department of Surgery, Madigan Army Medical Center, MCHJ-SGY, Tacoma, WA 98431, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Martin
authors.forename: Philip S
authors.initials: PS
authors.lastname: Mullenix
authors.forename: Scott R
authors.initials: SR
authors.lastname: Steele
authors.forename: Craig S
authors.initials: CS
authors.lastname: See
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Cuadrado
authors.forename: Preston L
authors.initials: PL
authors.lastname: Carter
mesh_terms: D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D015992:Body Mass Index; D001835:Body Weight; D015897:Comorbidity; D003680:Deglutition Disorders / Q000209:etiology; D004941:Esophagitis / Q000209:etiology; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D018579:Patient Selection; D010437:Peptic Ulcer / Q000209:etiology; D011446:Prospective Studies; D012086:Reoperation / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D016037:Single-Blind Method; D013997:Time Factors; D017211:Treatment Failure; D014839:Vomiting / Q000209:etiology; D015431:Weight Loss