Revisional bariatric surgery is more effective for improving obesity-related co-morbidities than it is for reinducing major weight loss.
BACKGROUND
Patients having previous bariatric surgery are at risk for weight regain and return of co-morbidities. If an anatomic basis for the failure is identified, many surgeons advocate revision or conversion to a Roux-en-Y gastric bypass. The aim of this study was to determine whether revisional bariatric surgery leads to sufficient weight loss and co-morbidity remission.


METHODS
From 2005-2012, patients undergoing revision were entered into a prospectively maintained database. Perioperative outcomes, including complications, weight loss, and co-morbidity remission, were examined for all patients with a history of a previous vertical banded gastroplasty (VBG) or Roux-en-Y gastric bypass (RYGB).


RESULTS
Twenty-two patients with a history of RYGB and 56 with a history of VBG were identified. Following the revisional procedure, the RYGB group experienced 35.8% excess weight loss (%EWL) and a 31.8% morbidity rate. For the VBG group, patients experienced a 46.2% %EWL from their weight before the revisional operation with a 51.8% morbidity rate. Co-morbidity remission rate was excellent. Diabetes (VBG:100%, RYGB: 85.7%), gastroesophageal reflux disease (VBG: 94.4%, RYGB: 80%), and hypertension (VBG: 74.2%, RYGB:60%) demonstrated significant improvement.


CONCLUSIONS
Revision of a failed RYGB or conversion of a VBG to a RYGB provides less weight loss and a higher complication rate than primary RYGB but provides an excellent opportunity for co-morbidity remission.
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. Electronic address: dmckenna@iupui.edu.
Daniel
D
McKenna
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
Don
D
Selzer
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
Michael
M
Burchett
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
Jennifer
J
Choi
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
Samer G
SG
Mattar
D000328:Adult; D015992:Body Mass Index; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000517:prevention & control*; D015391:Gastroplasty / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D015431:Weight Loss
Bariatric surgery; Co-morbidity remission; Revision; Weight regain