Outcomes of Laparoscopic Roux-en-Y Gastric Bypass As a Primary Versus Revisional Bariatric Surgery.

BACKGROUND: The purpose of this study was to compare the outcomes of laparoscopic Roux-en-Y gastric bypass (LRYGB) as a primary (CG) versus revisional bariatric surgery (RBS).

METHODS: Data of 514 consecutive patients who underwent LRYGB by one surgeon between August 2004 and June 2009 as primary (n=481, 93.6%) or RBS (n=33, 6.4%) were compared. Collected data included age, body mass index (BMI), operative time (OT), length of hospital stay (LOS), conversion to open surgery, early (< 30 days), or late (> 30 days) major complications, % excess weight loss (%EWL), status of comorbidities including hypertension (HTN), diabetes (DM), gastro-esophageal reflux disease (GERD), obstructive sleep apnea (OSA) and dyslipidemia, as well as score change of SF-36 quality of life (QoL) questionnaire. Indications for RBS included inadequate weight loss (n=13), intractable GERD (n=12), weight regain (n=10), abdominal pain (n=6), intractable or perforated ulcer (n=3), and anastomotic stricture (n=1). RBS procedures included: 1) conversion to Roux-en-Y gastric bypass of jejuno-ileal bypass (n=2), adjustable gastric band (n=5), sleeve gastrectomy (n=1), vertical banded gastroplasty (n=8), Nissen fundoplication (n=4), 2) revision of gastrojejunostomy (n=8), 3) Roux limb lengthening (n=5), 4) resection of Roux limb blind loop end (n=2) and 5) revision of gastric pouch (n=1). Differences in continuous and categorical variables between groups were explored with analysis of covariance (ANCOVA) and multinomial logistic regression respectively, both models adjusting for BMI, age and gender. P < 0.05 was considered significant.

RESULTS: There was a significant difference between CG and RBS groups in relation to BMI (47.2 vs. 38.6 Kg/m2, p<.001), but not age (42.3 vs. 45.2 years, p=.137). Compared to the CG, RBS patients had significantly longer OT (337.6 vs. 224.0 min, p <0.001), LOS (3.9 vs. 2.0 days, p <0.001) and higher conversion rates (18.2% vs 0.4%, p < 0.001). Although early major morbidity was higher in RBS patients (26.9% vs 4.7%, p=.002), late major complications were similar (8% RBS vs. 5.2% CG, p=.321). At an average follow-up of 12.1 months, 95.2% of RBS patients reported improvement of symptoms related to original bariatric procedure. %EWL at 1 year was greater for the CG (57% vs. 44.3%, p <0.001). Both patient groups reported significant improvement in all co-morbidities at 1-year follow-up. Percentage improvement of HTN (91.7% vs. 88.2%), DM (88.9% vs. 95.3%), OSA (66.7% vs. 84.7%) and dyslipidemia (50% vs. 62.4%) was similar in RBS and CG respectively, whereas GERD improvement was reported more frequently in the CG (100% vs. 81%, p<.001). At 6-month follow-up RBS patients reported lower QoL scores for the physical component (44.9 vs. 52.1, p=.009), whereas QoL scores for the mental component were similar in both groups (51.2 vs 53.4, p=.077).

CONCLUSIONS: Although RBS is associated with higher conversion rates, laparoscopic approach is feasible in more than 80% of patients. RBS carries higher peri-operative risks, but long-term risks are similar to the CG. Weight loss after RBS is significantly lower compared to the CG, but long term improvement of pre-operative symptoms related to original bariatric surgery and associated co-morbidities is very likely.

Session: Podium Presentation

Program Number: S062

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