Revisional Surgery in Bariatrics: A Surgical Dilemma

Alejandro Rodriguez-Garcia, MD, Mario Rodarte-Shade, MD, Rene Palomo-Hoil, MD, Roberto Rumbaut, MD. School of Medicine and Health Sciences at Tec de Monterrey.

Introduction
Bariatric procedures are prone to failure. As the number of procedures performed increases, more reoperations/revisions will likely be needed. Current incidence of reoperation ranges between 5 and 56%. The aim of this study is to show our experience with laparoscopic bariatric reoperative surgery.

Methods
From 2004 to 2011, 96 patients have been reoperated for failure of a primary bariatric procedure. Procedures were performed at a single private institution in Monterrey, Mexico. Indications for reoperation or revisional surgery were unsatisfactory weight loss, weight regain, metabolic/nutritional complications, intolerable adverse effects or mechanical complications.

Results
A total of 96 patients with a mean age of 42 years (range 19 – 71) had laparoscopic revisional surgery. Sex distribution was 70% females and 30% males. Revisional procedures performed were as follows: 62 patients had an adjustable gastric band (AGB) converted to a Roux-en-Y gastric bypass (RYGB), 14 patients had an AGB converted to sleeve gastrectomy (SG), 11 patients had an AGB removed or replaced, and 4 patients had an AGB on a RYGB. Other less common revisional procedures performed were surgical reduction of large gastric pouch (n=3) and conversion of SG to RYGB (n=2).

Conclusions
Bariatric surgery is prone to failure due to patient and technical factors. Surgeons should be prepared to reoperate on these technically demanding cases. Although morbidity is higher, laparoscopic revisions can be performed satisfactorily with acceptable results.
 

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