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Dual Academic Institutional Experience of Secondary Operations after Sleeve Gastrectomy

Victoria Lyo, MD1, Ryan Macht2, Yalini Vigneswaran1, Andrew Posselt2, Jonathan Carter2, Stanley Rogers2, Andrea Stroud1, Stephanie Wood1, Farah Husain1. 1OHSU, 2UCSF

INTRODUCTION: Although laparoscopic sleeve gastrectomy (LSG) is the most common bariatric operation performed, patients can experience severe GERD, strictures, insufficient weight loss, and leaks. The incidence, indications, and patient outcomes of a secondary operation or conversion to bypass are not well understood.

METHODS AND PROCEDURES: We reviewed institutional MBSAQIP data from two academic, tertiary referral centers for bariatric operations between 2014-2018. We identified patients who underwent secondary operations after LSG and evaluated their demographics and early postoperative outcomes.

RESULTS: Of the 1713 bariatric operations performed, 316 (18.4%) were secondary after prior bariatric surgery: 165 after gastric banding, 82 after bypass, and 55 after LSG. We identified 49 operations after LSG in 42 patients, excluding six port-site hernia repairs. Seven of the 49 cases were washouts or tube placements in duplicate patients. Most LSGs (32/49, 65.3%) were performed outside of our institutions. Mean time to revisions was 2.7 years (range: 0.23-9.1 years).

Among the 42 reoperative LSG patients, 32 (76.2%) had conversions from sleeve to bypass. Of these conversions, three had concurrent HH repairs and one had a concurrent Heller myotomy. The remaining 10 patients had: four HH repairs, two gastroplasties, one incisural seromyotomy, one sleeve fundal revision, one conversion to esophago-jejunostomy for a chronic GC fistula, and one gastrobronchial fistula takedown.

Most patients had multiple indications for reoperation. Grouped by primary indication, the most frequent reason for surgery after LSG was GERD in 17 patients, four of whom had esophagitis, four HHs, and three inadequate weight loss. Of all patients with GERD (26 patients), 84.6% had their symptoms resolve with reoperation. Two of the four without resolution of GERD had a sleeve revision or HH repair alone.

Of the nine patients who had incisural strictures, six had resolution of oral intolerance after revision; three patients had persistent nausea with no strictures on EGD.  All eight patients undergoing conversions for inadequate weight loss (baseline BMI 56.7kg/m2 to post-LSG BMI 48.8, EBWL 21.1%) had successful weight loss to an average BMI of 44.7 and EBWL to 40.2%. One of seven reoperations for fistulas or leaks failed leak closure. Among all reoperative 42 patients, 14 patients (33.3%) had complications requiring further procedures.

CONCLUSION: Symptoms and complications after LSG can persist and these patients may need secondary operations. At our tertiary bariatric centers, secondary operations successfully treated the primary indications for reoperation and should be offered, but can be challenging with higher complication rates.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 94910

Program Number: P189

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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