title: Should bariatric revisional surgery be avoided secondary to increased morbidity and mortality?
abstract: BACKGROUND
  Revisional bariatric surgery may be necessary due to inadequate weight loss or postoperative complications of the primary operation. We sought to identify the reasons for revision, characteristics of the surgery, and outcomes. We hypothesize that revisional surgery, although technically challenging, can produce desirable outcomes.
  
  
  METHODS
  Patients undergoing bariatric surgery at our institution between 1998 and 2007 were reviewed from a prospective database. Patients who had revisional surgery were compared to those who had primary surgery.
  
  
  RESULTS
  We have identified 46 of 1,038 patients who underwent revisional surgery. Twenty of 46 had a primary Roux-en-Y gastric bypass. The most common indication for revisions is inadequate weight loss secondary to gastrogastric fistula (15/20). Leaks occurred more frequently following revisional surgeries (11% vs 1.2%), but intensive care unit (ICU) utilization was less (11% vs 4.4%) and mortality was lower (0% vs .3%) with bariatric revision surgery.
  
  
  CONCLUSIONS
  Although we saw a 9-fold increase in leaks, a 2-5 fold increase in ICU utilization, and 1.5-fold increase in length of stay, our mortality rate was zero. In experienced hands, bariatric revision surgery can be performed to produce desirable outcomes.
authors.affiliation: University Hospitals Case Medical Center Department of Surgery, Case Western Reserve University, School of Medicine, Cleveland, OH 44106, USA. peter.hallowell@uhhospitals.org
authors.forename: Peter T
authors.initials: PT
authors.lastname: Hallowell
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Stellato
authors.forename: David A
authors.initials: DA
authors.lastname: Yao
authors.forename: Ann
authors.initials: A
authors.lastname: Robinson
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Schuster
authors.forename: Kristen N
authors.initials: KN
authors.lastname: Graf
mesh_terms: D000328:Adult; D004066:Digestive System Diseases / Q000209:etiology / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D015430:Weight Gain