Revisional bariatric surgery: 13-year experience from a tertiary institution.
OBJECTIVE
To evaluate the safety and effectiveness of revisional bariatric surgery at a tertiary institution. Revisional bariatric operations for unsuccessful weight loss or intolerable complications following the primary intervention are increasing.


METHODS
Case series from a prospective database.


METHODS
Tertiary bariatric referral center.


METHODS
From 1995 to 2008, 56 patients who had been formerly operated on for clinically severe obesity underwent a revisional procedure at our institution. Their mean (SD) age and body mass index were 39.6 (9.6) years and 46.9 (16.4), respectively. They were divided into 3 groups according to the indications for reoperation: (1) unsatisfactory weight loss (n = 39), (2) severe nutritional complications (n = 15), and (3) intolerable adverse effects (n = 2).


METHODS
Effectiveness of the procedures according to the indication of revision and overall morbidity and mortality rates.


RESULTS
Mean (SD) follow-up was 102 (8) months. There was no mortality but there was an early morbidity rate of 33.9% due to postoperative complications, including 2 cases of acute renal failure (3.6%), 5 anastomotic leaks (13.1%), 8 cases of pneumonia (14.3%), and 1 case each of wound infection, incisional dehiscence, bile leak, and small-bowel obstruction (1.8%). Late complications included stenosis of the gastrojejunal anastomosis in 2 patients (3.6%), hypoalbuminemia in 2 patients (3.6%), and incisional herniation in 9 patients (16.1%). Late morbidity was 23.2%.


CONCLUSIONS
Although revisional bariatric surgery is associated with higher risk of perioperative complications compared with the primary procedures, it appears to be safe and effective when performed in experienced centers.
Department of Surgery, School of Medicine, University of Patras, Greece, Platia Voriou Ipirou 5, Patras, Greece.
Charalambos
C
Spyropoulos
Ioannis
I
Kehagias
Spyros
S
Panagiotopoulos
Nancy
N
Mead
Fotis
F
Kalfarentzos
D000328:Adult; D050110:Bariatric Surgery; D015992:Body Mass Index; D015331:Cohort Studies; D006801:Humans; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D015431:Weight Loss