title: Worthy or not? Six-year experience of revisional bariatric surgery from an Asian center of excellence.
abstract: BACKGROUND
  Revisional bariatric surgery (RBS) is increasing. The various primary operations with their distinctive complications make this group of patients quite heterogeneous, and treatment has to be individualized. There are concerns regarding the safety profile and efficacy of these procedures. The objective of the present study was to analyze the indications, safety, and efficacy of RBS at a high-volume Asian center and provide insight into the different treatment options.
  
  
  METHODS
  Of a total of 1578 bariatric surgeries from July 2006 to June 2012, 52 patients underwent revisional bariatric procedures. The primary operations included 6 different procedures. The indications for surgery were grouped into weight loss failure (n = 21) or complications related to the primary operation (n = 31). The revisional operations performed were conversion to another procedure (n = 22), revision of existing anatomy (n = 29), or reversal to normal anatomy (n = 1).
  
  
  RESULTS
  96% of revisional surgeries were performed laparoscopically. The median operating time was 72 minutes (25-240 min), and the median duration of hospital stay was 4 days (3-25 d). The mean body mass index for weight loss failure decreased significantly from 36.3 to 29.6 kg/m(2) after 1 year of revisional surgery (P<.01). However, revision of RYGB was only associated with a body mass index loss of 3.2 kg/m(2) and percentage of excess weight loss of 31.8%. More than 90% of the patients with complications had complete resolution of their preoperative symptoms. There were 3 major complications with an overall morbidity rate of 5.8%. There was no mortality.
  
  
  CONCLUSIONS
  RBS is well-tolerated, with satisfactory early outcomes, in high-volume centers. However, larger studies with longer follow-up periods are needed to determine the long-term efficacy of these procedures.
authors.affiliation: Bariatric and Metabolic International Surgery Centre, E-Da Hospital, Taiwan, Republic of China.
authors.forename: Anirudh
authors.initials: A
authors.lastname: Vij
authors.affiliation: Bariatric and Metabolic International Surgery Centre, E-Da Hospital, Taiwan, Republic of China.
authors.forename: Kirubakaran
authors.initials: K
authors.lastname: Malapan
authors.affiliation: Department of Pediatrics, E-Da Hospital, Taiwan, Republic of China.
authors.forename: Ching-Chung
authors.initials: CC
authors.lastname: Tsai
authors.affiliation: Department of Anesthesia, E-Da Hospital, Taiwan, Republic of China.
authors.forename: Kuo-Chung
authors.initials: KC
authors.lastname: Hung
authors.affiliation: Bariatric and Metabolic International Surgery Centre, E-Da Hospital, Taiwan, Republic of China; Department of General Surgery, E-Da Hospital, Taiwan, Republic of China.
authors.forename: Po-Chi
authors.initials: PC
authors.lastname: Chang
authors.affiliation: Bariatric and Metabolic International Surgery Centre, E-Da Hospital, Taiwan, Republic of China; Department of General Surgery, E-Da Hospital, Taiwan, Republic of China. Electronic address: dr.ckhuang@hotmail.com.
authors.forename: Chih-Kun
authors.initials: CK
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D050110:Bariatric Surgery; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology*; D055815:Young Adult
keywords: Bariatric; Morbid obesity; Revisional surgery