Iman Ghaderi, MD, MSc, Amlish Gondal, MD, Carlos Galvani, MD. University of Arizona
Introduction: Revisional bariatric surgery has become more common in recent years. It is to address short and long-term complications of primary bariatric surgery as well as the issue of weight regain. The aim of this study was to retrospectively analyze the indications for reoperation and short-term outcomes in our institution.
Methods and procedures: Between 2011 and 2017, patients who underwent bariatric surgery in our center were included in a prospectively collected database. Demographic data, primary and revisional bariatric procedures, reasons for revisions and outcomes were recorded and reviewed retrospectively.
Results: A total of 527 patients underwent bariatric surgery at our institution and 22% of these (n=119) were revisional bariatric surgery. We identified 4 groups of patients according to their primary procedures: Adjustable gastric band (AGB), Roux- en-Y gastric bypass (RYGBP), Vertical band Gastroplasty (VBG), and Sleeve gastrectomy (SG). Of the 119 patients, 51 (43%) had ABG as primary procedure. Of those, 55% had their band removed due to food intolerance and severe dysphagia and 37% had a conversion to either RYGBP or Sleeve gastrectomy (SG) due to weight recidivism. In the RYGPBP group (n=38), 53% of the patients presented with late complications. Of these, 45% had an acute presentation (small bowel obstruction, internal hernia, or perforated marginal ulcer) requiring emergency surgery. Only 8% patients needed gastric bypass takedown due to severe hypoglycemia. Weight recidivism was noted in 47% of the patients that necessitated either revising the anastomosis, trimming of the gastric pouch or gastrogastric fistula takedown. In the VBG group (n=14), 79% of the patients experienced weight recidivism that required conversion to RYGB and 21% of the patients required the VBG to be taken down due to obstructive symptoms. In the SG group (n=14), 21% of the patients experienced early complications needing a second procedure. Weight recidivism was found as the most common reason for conversion (50%) to RYGBP. Twenty nine percent of the patients in this group underwent conversion to a RYGBP due to severe de novo GERD.
Conclusions: Our results demonstrate various reasons for revisional surgery in our bariatric surgery population. The complications rate after revisional bariatric surgery is low and it should be offered to patients who can benefit from reoperation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88587
Program Number: P618
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster