Revisional bariatric surgery by conversion to gastric bypass or sleeve--good short-term outcomes at higher risks.
This is a retrospective study of prospectively collected data from 34 patients who had revisional bariatric surgery at a single centre. The aim was to report the indications for revisional surgery, operative time, conversion to open surgery, mortality, hospital stay, early and late complications, reoperations and short-term efficacy. From 2006 to 2011, 31 patients who formerly had been operated for morbid obesity with restrictive operations and 3 patients who had been operated in the upper abdomen for other morbidities (fundoplications 2, Heller's myotomy 1) underwent a revisional Roux-en-Y gastric bypass operation (n = 30) or sleeve gastrectomy (n = 4). Demographic data, perioperative characteristics and follow-up data were entered prospectively in the hospital's database for bariatric patients. Twenty-five operations were done by laparoscopic and nine by open technique. The mean operative time was 113.17 (33.98, 54-184) min. The mean postoperative hospital stay was 3.25 (5.71, 1-32) days. Intra-operative complications occurred in six patients (17.65%), postoperative complications in nine (26.47%), and major complications in three patients (8.82%), including leakage in the gastrojejunal anastomosis in two (5.88%) patients. The conversion rate to open surgery was 2.94% (one emergency patient). There was no mortality. Excess weight loss (%, ± SD) at 3 months follow-up averaged 42.31%, ± 21.54. Revisional bariatric surgery can be performed with an increased but acceptable risk, with at least short-term weight loss comparable to primary operations.
Department of Gastrointestinal Surgery, Vaasa Central Hospital, Hietalahdenkatu 2-4, 65130 Vaasa Hospital District, Vaasa, Finland. mikael.victorzon@vshp.fi
Mikael
M
Victorzon
D000328:Adult; D000713:Anastomosis, Roux-en-Y; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D015390:Gastric Bypass / Q000009:adverse effects; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss