Long-term Outcomes of Revision of Failed Bariatric Operations with Weight Regain to Roux-En Y Gastric Bypass

Daniel T McKenna, MD, Samer Mattar, MD, Daniel Mwanza, DO, Michael Burchett, DO, Lori Blythe, APRN, Jennifer Choi, MD, Don Selzer, MD

Indiana University School of Medicine

Introduction: Many patients with a history of failed or complicated bariatric operations seek revision. Reoperative gastric surgery is associated with increased perioperative risk and uncertain benefit.

Methods and Procedures: A retrospective cohort analysis of all patients who underwent conversion of Vertical Banded Gastroplasty (VBG) or Roux en-y Gastric bypass (RNYGB) to RNYGB between January 2005 and January 2011 was conducted.

Results: All patients undergoing revision with weight regain between January 2005 and January 2011:

Mean Age (years)50.249.4
Mean BMI47.9 41.9
Mean length of stay (days)6.24.3
Mean operative time (minutes)183.3186.3
Mean follow up (months)19.218.1
Mean Weight Loss (lbs)66.745.4
Mean Complication Rate49%31.8%

There were 22 RYGB patients with a history of weight regain who underwent RNYGB revisional surgery with the following indications: Gastrogastric (G-G) fistula (8), G-G fistula and large pouch (3), G-G fistula and large stoma (1), large pouch (7), gastrojejunal stricture (1), and widened stoma (2). There were 21 females and 1 male. There were 3 open cases, two of which were conversions to open because of uncontrolled hemorrhage, with one splenectomy.

Fifty-three patients underwent a conversion of VBG to a RNYGB. In addition to weight regain, the additional surgical indications included an enlarged pouch (16); band erosion/stricture (5), staple line dehiscence (11), intractable nausea and vomiting (3), and medically recalcitrant GERD with associated hiatal hernia (8). Eighteen procedures were completed open, 31 were completed laparoscopically, and 4 were converted from laparoscopic to open.

Twenty-six patients following VBG-RNY conversion (49%) and 7 patients following RNY revision (31.8%) had major or minor complications. Readmission rates were 17.0% and 22.7% for VBG and RNYGB conversion respectively. VBG to RNYGB patients had 3 anastomotic leaks (11.3%), bleeding (15.1%), stricture (7.5%) and one death (1.9%) due to leak and sepsis. RNY revisions had anastomotic leaks (9.1%), strictures (9.1%), readmission (22.7%), and wound infection (9.1%).

Conclusion: In midterm follow-up, conversion of vertical banded gastroplasty to Roux-en Y gastric bypass and revision of Roux-en Y Gastric Bypass are associated with high complication rate and modest weight loss. Prospective patients should be counseled accordingly.

Session: Poster Presentation

Program Number: P449

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