title: The anatomy of a weight recidivism and revision bariatric surgical clinic.
abstract: Abstract. Weight recidivism in bariatric surgery failure is multifactorial. It ranges from inappropriate patient selection for primary surgery to technical/anatomic issues related to the original surgery. Most bariatric surgeons and centers focus on primary bariatric surgery while weight recidivism and its complications are very much secondary concerns. Methods. We report on our initial experience having established a dedicated weight recidivism and revisional bariatric surgery clinic. A single surgeon, dedicated nursing, dieticians, and psychologist developed care maps, goals of care, nonsurgical candidate rules, and discharge planning strategies. Results. A single year audit (2012) of clinical activity revealed 137 patients, with a mean age 49 ± 10.1 years (6 years older on average than in our primary clinic), 75% of whom were women with BMI 47 ± 11.5. Over three quarters had undergone a vertical band gastroplasty while 15% had had a laparoscopic adjustable gastric band. Only 27% of those attending clinic required further surgery. As for primary surgery, the role of the obesity expert clinical psychologist was a key component to achieving successful revision outcomes. Conclusion. With an exponential rise in obesity and a concomitant major increase in bariatric surgery, an inevitable increase in revisional surgery is becoming a reality. Anticipating this increase in activity, Alberta Health Services, Alberta, Canada, has established a unique and dedicated clinic whose early results are promising.
authors.affiliation: University of Alberta, 2-590 Edmonton Clinic Health Academy, Edmonton, AB, Canada T6G 1C9 ; Bariatric Revision Surgery Clinic, Alberta Health Services, Edmonton, AB, Canada T5H 3V9.
authors.forename: C J
authors.initials: CJ
authors.lastname: de Gara
authors.affiliation: Surgical Director Weight Wise Bariatric Clinic, Minimally Invasive Gastrointestinal and Bariatric Surgery, Alberta Health Services, Edmonton, AB, Canada T5H 3V9.
authors.forename: S
authors.initials: S
authors.lastname: Karmali