title: Management of Complications and Outcomes After Revisional Bariatric Surgery: 3-Year Experience at a Bariatric Center of Excellence.
abstract: Laparoscopic revisional bariatric surgery (RBS) is increasingly common. A tailored decision-making process is advocated. In this retrospective study, we reviewed the RBS experience of a single center, analyzing perioperative complications to provide insight into management options and midterm outcomes.
  
  
  
  Records from November 2011 to March 2015 were reviewed from prospectively maintained database. Six hundred eighteen patients underwent laparoscopic bariatric procedures; of these, 81 (13.1 %) underwent RBS. Patients with a minimum follow-up of 6 months (n = 77) were evaluated. Fifty-nine underwent revised laparoscopic sleeve gastrectomy, and 18 underwent revised Roux-en-Y gastric bypass. Indications for RBS were inadequate weight loss or weight regain in 42 cases (54.5 %) and gastroesophageal reflux disease (GERD), procedure-related complications, or technical failure in 35 cases (45.5 %).
  
  
  
  There were no deaths or conversions to open surgery. After a mean follow-up of 22 months, body mass index (BMI) decreased from 40.9 ± 6.7 to 31.9 ± 4.8 kg/m(2), mean % excess weight loss (%EWL) was 58 ± 24.3 %, and 55.3 % of patients had resolution of comorbidities. Eight major complications (10.4 %) occurred: five leaks and three intra-abdominal hematomas. Non-surgical management succeeded in 50 % of complications.
  
  
  
  This study confirms that RBS is challenging; a complication rate of 10 % is expected. Major surgery can be avoided when devoted endoscopists and radiologists are available. Intensive follow-up after complications allows early diagnosis and treatment of unfavorable sequelae. RBS induced a mean %EWL of 58 % at 2 years and resolution of comorbidities in 50 % of cases. However, the durability of these effects remains questionable.
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Center of Excellence IFSO EU, "La Sapienza", University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy.|Gastroenterology Surgical Center, Faculty of medicine, Mansoura University, Mansoura, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdelgawad
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Center of Excellence IFSO EU, "La Sapienza", University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: De Angelis
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Center of Excellence IFSO EU, "La Sapienza", University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Iossa
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Center of Excellence IFSO EU, "La Sapienza", University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzello
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Center of Excellence IFSO EU, "La Sapienza", University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cavallaro
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Center of Excellence IFSO EU, "La Sapienza", University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy. gianfranco.silecchia@uniroma1.it.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Silecchia
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation / Q000009:adverse effects / Q000706:statistics & numerical data; D012189:Retrospective Studies
keywords: Complications; Fistula; Laparoscopic surgery; Leak; Morbid obesity; Revisional bariatric surgery
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