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:

VBG RNYGB
Patients 53 22
Mean Age (years) 50.2 49.4
Mean BMI 47.9 41.9
Mean length of stay (days) 6.2 4.3
Mean operative time (minutes) 183.3 186.3
Mean follow up (months) 19.2 18.1
Mean%EWL 46.4 39
Mean Weight Loss (lbs) 66.7 45.4
Mean Complication Rate 49% 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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