Short-term results of revision and conversion bariatric operations

Pornthep Prathanvanich, MD, Eric Marcotte, MD, Bipan Chand, MD. Loyola University Medical Center

Background: All bariatric operations have an incidence of failure. Revising the gastrojejunostomy (GJ) and gastric pouch in gastric bypass operations can be performed surgically or endoscopically. Weight regain after the adjustable gastric band is common converted to either sleeve gastrectomy or gastric bypass. The aim of this study is to determine the feasibility and outcomes of surgical conversion and revision in failed bariatric surgery

Method: This is a retrospective study of 34 patients.  Patients underwent conversion of gastric banding to gastric bypass {N=8} and sleeve gastrectomy {N=2} as a one stage procedure, and revisions were offered to 24 patients that had prior gastric bypass.  Revisions were of the GJ {N=14} and endoscopic suturing {N=10}

Weight recidivism can be classified into weight regain (gain of 20% of maximum weight lost){N=27} or inadequate weight loss (defined as %EWL < 50%) {N=7}.

All patients underwent preoperative preparation with multi-disciplinary counseling into etiology of failure, upper endoscopy and contrast imaging.

Result: Between 2012 to 2015, 34 consecutive patients (Female = 29, mean body mass index: BMI = 45.80 kg/m2, and mean age = 46.21) had a conversion and revision from a primary bariatric surgery.

Time between primary bariatric surgery and revision or conversion was 9.32±3.07 {Range: 3-14 years}.

Mean intraoperative blood loss was 29.38 ml with no intraoperative complications. Two (2/34:8.82%) major post-op complications occurred early and included one pseudo-Peterson’s hernia in a patient that underwent conversion of gastric banding to gastric bypass and one patient with an omental bleed after laparoscopic revision of the GJ.

Mean follow up time was 10.42 months with mean excess weight loss of 26.73% and mean total body weight loss (TBWL) of 18.98 kg. Mean TBWL of surgical conversion of gastric banding to another bariatric surgery (32.34 kg) was more than of surgical revision of a gastric bypass (13.42 kg) significantly (p = 0.007).

Conclusion: The conversion from gastric banding to gastric bypass or sleeve gastrectomy can safely be performed in one stage at an experienced bariatric center and offers significant weight loss.  Revising the anatomy of a gastric bypass is technically feasible and can safely be performed in select patients. However, weight loss may be modest and timing of the second intervention from index operation may impact subsequent weight loss.  

First visit BMI (kg/m2)45.80
Excess weight loss (%)26.73
TBWL (kg)18.98

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