title: A two-decade spectrum of revisional bariatric surgery at a tertiary referral center.
abstract: BACKGROUND
  Ineffective weight loss or complications of previous bariatric surgery often require revisional bariatric procedures. Our aim was to define the indications, operative approach, and outcomes of revisional bariatric procedures during 2 decades at a tertiary center.
  
  
  METHODS
  From our prospective database (n = 1584), including 1985-2004, 218 patients (14%) underwent revisional bariatric procedures. Follow-up (mean 7 yr, range 1 mo to 19 yr) data obtained from patient records and questionnaires were current for 98%. Patients were grouped according to operative indications: group 1, unsatisfactory weight loss (n = 97); group 2, mechanical/symptomatic complications (n = 95); and group 3, severe nutritional/metabolic problems (n = 26).
  
  
  RESULTS
  The operative mortality rate was 0.9% (1 case each of pulmonary embolus and cardiac arrest). The serious operative morbidity rate was 26% (wound infection in 13%, leak in 3%, pulmonary embolus in 2%, anemia/hemorrhage in 2%, pneumonia/prolonged ventilation in 2%, and other in 4%). Of the 218 patients, 94% underwent conversion to, or revision of, Roux-en-y gastric bypass. Group 1 achieved substantial weight reduction with a mean body mass index from 51 +/- 1 to 38 +/- 1 kg/m(2), the complications resolved in 88% of group 2, and the nutritional/metabolic problems resolved in 79% of group 3. Patients who underwent revisional surgery 1990 were more likely to present with mechanical/symptomatic/metabolic complications than for unsuccessful weight loss (P <.001).
  
  
  CONCLUSIONS
  Revisional bariatric surgery is safe and effective in experienced centers. Complications (mechanical/symptomatic/nutritional) or unsatisfactory weight loss after primary bariatric procedures can be treated effectively with revision to Roux-en-y gastric bypass.
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Nesset
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kendrick
authors.forename: Scott G
authors.initials: SG
authors.lastname: Houghton
authors.forename: Jane L
authors.initials: JL
authors.lastname: Mai
authors.forename: Geoffrey B
authors.initials: GB
authors.lastname: Thompson
authors.forename: Florencia G
authors.initials: FG
authors.lastname: Que
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Thomsen
authors.forename: Dirk R
authors.initials: DR
authors.lastname: Larson
authors.forename: Michael G
authors.initials: MG
authors.lastname: Sarr
mesh_terms: D050110:Bariatric Surgery / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies