title: Revisionary bariatric surgery: indications and outcome of 100 consecutive operations at a single center.
abstract: BACKGROUND
  A growing number of revisionary and secondary bariatric operations have been performed in recent years, with the number of operations doubling each year at the authors' center. Diagnostics, indications, and most revisionary operations should be performed by an experienced bariatric surgeon. This study was undertaken to evaluate indications and outcomes of revisionary bariatric operations at a specialized center.
  
  
  METHODS
  At the Centre of Obesity and Metabolic Surgery (University of Freiburg, Germany), 100 consecutive revisionary bariatric operations performed between March 2007 and September 2009 were analyzed concerning indications and outcomes.
  
  
  RESULTS
  Only 9 of the 100 revisions were due to early complications (<30 days after the primary operation). The indication for most revisions was poor weight loss (n = 55). A mean body mass index reduction of 10 points could be achieved in 1 year, which equals a 56% excess weight loss (EWL). No significant difference in weight reduction between restrictive and malabsorptive revisions was observed. Revisions due to implant-related problems also were frequent (n = 25). Laparoscopic revision was possible in 95% of the cases.
  
  
  CONCLUSIONS
  Insufficient weight loss is the most frequent indication for revisionary bariatric surgery. The surgery can be performed laparoscopically in most cases, and a significant EWL (> 50%) can be achieved in 1 year if the right revisionary procedure is chosen.
authors.affiliation: Department of General and Visceral Surgery, University of Freiburg, Surgical Metabolic and Anastomotic Research Team, Hugstetter Strasse 55, 79106 Freiburg, Germany. simon.kuesters@uniklinik-freiburg.de
authors.forename: Simon
authors.initials: S
authors.lastname: Kuesters
authors.forename: Jodok M
authors.initials: JM
authors.lastname: Grueneberger
authors.forename: Tobias
authors.initials: T
authors.lastname: Baumann
authors.forename: Waleed
authors.initials: W
authors.lastname: Bukhari
authors.forename: Marc
authors.initials: M
authors.lastname: Daoud
authors.forename: Ulrich T
authors.initials: UT
authors.lastname: Hopt
authors.forename: Wojciech K
authors.initials: WK
authors.lastname: Karcz
mesh_terms: D050110:Bariatric Surgery / Q000379:methods*; D015992:Body Mass Index; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss