Revisional bariatric surgery can improve refractory metabolic disease.
BACKGROUND
It remains unclear if patients undergoing revisional surgery for inadequate weight loss/recidivism can achieve improvement of refractory metabolic syndrome (MetS).


OBJECTIVE
We aimed to evaluate metabolic outcomes after reoperative bariatric surgery for unsatisfactory weight loss in patients with refractory MetS.


METHODS
Academic Hospital.


METHODS
We retrospectively reviewed all revisional bariatric surgery cases performed for inadequate weight loss/recidivism at our center and analyzed all cases in which the patient had ongoing uncontrolled diabetes or MetS.


RESULTS
In total, 121 reoperative bariatric cases for inadequate weight loss/recidivism were identified. Of those, 31.4% (N = 38) had MetS and 33.9% (N = 41) were diabetic at the time of primary bariatric surgery. At revisional surgery, 15 (39.5%) patients still met criteria for MetS and 7 (17.1%) had hemoglobin A1c (HbA1c)≥6.0%. Of those with refractory MetS (N = 15) at revisional surgery, a mean percent excess weight loss (%EWL) of 59.4±21.2% at mean 40.1±29.9 months follow-up corresponded to a mean decrease in triglyceride of 65.2 mg/dL, mean increase in high-density lipoprotein cholesterol (HDL) of 12.1 mg/dL, and mean decrease in plasma glucose of 58.8 mg/dL. Mean percent total weight loss was 27.3%. One patient still met criteria for MetS. Of those with HbA1c≥6.0% at reoperative surgery (N = 7), a mean %EWL of 63.0±22.9% at mean 51.6±36.6 months follow-up corresponded to a mean decrease in HbA1c of 1.6%. Three patients still had HbA1c≥6.0%, but only 1 had HbA1c≥ 6.5%.


CONCLUSIONS
Although further research is needed, this report suggests that revisional bariatric surgery is capable of treating both inadequate weight loss and refractory metabolic disease.
Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
Christopher R
CR
Daigle
Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
Rizwan
R
Chaudhry
Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
Mena
M
Boules
Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
Ricard
R
Corcelles
Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
Matthew
M
Kroh
Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
Philip R
PR
Schauer
Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: brethas@ccf.org.
Stacy A
SA
Brethauer
D000328:Adult; D050110:Bariatric Surgery / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000209:etiology*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss
D006442:Glycated Hemoglobin
Bariatric surgery; Conversion; Diabetes; Metabolic syndrome; Re-operative; Revision; Weight loss; Weight regain