title: Causes and outcomes of revisional bariatric surgery: initial experience at a single center.
abstract: OBJECTIVE
  Bariatric surgery has become more prevalent owing to the worldwide obesity epidemic. With the growing number of bariatric procedures performed annually, the requirement for revisional and secondary operations is increasing accordingly. This study aimed to evaluate the initial experience of revisional bariatric surgery at a single specialized center.
  
  
  METHODS
  A retrospective review of the prospectively established database identified all patients who underwent revisional bariatric surgery between January 2008 and August 2013. The causes, surgical outcomes, and efficacy of the revisional surgeries were analyzed.
  
  
  RESULTS
  Twenty-two revisional surgeries were performed laparoscopically during the study period (13 laparoscopic adjustable gastric banding, 9 laparoscopic sleeve gastrectomy). The most common indication for revision was weight regain or insufficient weight loss (12/23, 52.2%), and Roux-en-Y gastric bypass (RYGB) was the most commonly performed secondary procedure (17/23, 73.9%, including four resectional RYGB procedures). Gastric pouch leak occurred in one patient following revisional RYGB, which required reoperation on the first postoperative day. The mean body mass index decreased from 35.9 to 28.8 kg/m(2) at a mean follow-up period of 10 months after revision. The percent excess weight losses at 1, 3, 6, and 12 months postoperatively were 18.8%, 41.1%, 40.1%, and 47.4%, respectively.
  
  
  CONCLUSIONS
  Revisional bariatric surgery can be successfully performed via a laparoscopic approach with acceptable risk. Deliberate selection for the proper revisional procedure can efficiently manage undesirable results from the primary surgery.
authors.affiliation: Department of Surgery, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Ji Yeon
authors.initials: JY
authors.lastname: Park
authors.affiliation: Department of Surgery, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Dan
authors.initials: D
authors.lastname: Song
authors.affiliation: Department of Surgery, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Yong Jin
authors.initials: YJ
authors.lastname: Kim
keywords: Bariatric surgery; Gastric bypass; Morbid obesity; Reoperation