Initial Experience with Revisional Bariatric Surgery

Enrique F Elli, MD FACS, Lindberg K Simpson, MD, Osman Mahidi-Babikir, MD, Francesco M Bianco, MD, Mario A Masrur, MD, Nicolas C Buchs, MD, Pier C Giulianotti, MD FACS. Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA.

Introduction: With the increased demand for bariatric surgery procedures, patients who fail to lose weight after their initial operation may require a revisional procedure. These secondary procedures are more complex with increased morbidity and mortality and are not offered by all bariatric surgeons. We present here our initial experience with revisional bariatric surgery.

Methods: We reviewed a prospectively kept database of patients undergoing bariatric surgery performed by a single surgeon over 20 months. Anthropometric, peri-operative, and clinical follow-up data were collected and statistical analyses were performed.

Results :There were in total 17 patients requiring revisional procedures of which 13 had laparoscopic adjustable gastric banding (LAGB), three had roux-en-y gastric bypass (RYGB) and one had laparoscopic sleeve gastrectomy (LSG) as their primary procedure. Mean pre-operative weight and body mass index were 225.13 (168 – 355) lb and 41.28 (28.8 – 56.0) kg/m² respectively. Six LAGB patients had band repositioning while three were converted to RYGB and one converted to a sleeve gastrectomy. Three patients requested that their band be removed with no additional bariatric procedures. The patients with previous RYGB underwent trimming of the gastric pouch. The sole patient with LSG was converted to RYGB. All procedures were completed in a minimally invasive way with no intra-operative complications and all had intra-operative endoscopy and upper gastro-intestinal swallow study before discharge. The mean operating time was 185 (49 – 357) minutes and mean blood loss 21 (5 -80) ml. There was one major complication of a leak with intra-abdominal sepsis occurring nine days after the original operation and requiring emergency laparotomy and peritoneal lavage. This patient was kept on parenteral nutrition and eventually discharged home with no further complications.

Conclusions: Revisional bariatric surgery is technically challenging and should be performed by trained bariatric surgeons but longer follow-up is needed to determine the risk-benefit of the operation.