Revisional bariatric surgery at a single institution.
BACKGROUND
Bariatric surgery, although safe, can have long-term complications that require revision. Our series illustrates the spectrum of primary procedures, indications for surgery, and strategies for revision.


METHODS
The study was a retrospective chart review. Sixty-three patients were identified. Of specific interest were complications and percentage of excess weight loss (EWL) during the follow-up period.


RESULTS
Eighteen patients had a previous vertical banded gastroplasty (VBG), 26 had a Roux-en-Y gastric bypass (RYGB), 18 had a laparoscopic adjustable gastric banding (LAGB), and 1 had a jejunal-ileal bypass. All VBG patients were revised to RYGB. Seventeen RYGB patients were revised with RYGB. Eight LAGB patients were revised with RYGB. Eight RYGB patients had placement of LAGB. Two LAGB patients were revised with LAGB because of a slipped band. Eight LAGB patients had the band removed. The morbidity rate was 30% with a major morbidity rate of 11%. There were 2 leaks, neither required reoperation. Other major complications included 3 pneumonias, 2 reoperations, and 2 intra-abdominal abscesses. There were no mortalities. In the 15 patients who had conversion of VBG to RYGB, the mean EWL was 50%, with 60% of patients achieving more than 50% EWL. In the 10 patients who had revision of their RYGB, the mean EWL was 51%, with 60% of patients achieving more than 50%. In the 6 patients who had revision of LAGB to RYGB, the mean EWL was 39%, with 33% of patients achieving more than 50% EWL. In the 8 patients who had LAGB after RYGB the mean EWL was -2%, with 0% of patients achieving more than 50%.


CONCLUSIONS
Revisional surgery is effective, although complication rates are higher than primary bariatric surgery. The type of initial and revisional procedure affects EWL.
Department of Surgery, Northwestern University, Chicago, IL 60611, USA. j-fronza@md.northwestern.edu
Jeffrey Scott
JS
Fronza
Jay B
JB
Prystowsky
Eric S
ES
Hungness
Alexander P
AP
Nagle
D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects*; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007087:Illinois; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D015424:Reperfusion / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome