Revisional bariatric surgery: which the best choice?
A dual-institutional study.
EAES Academy. Fassari A. 07/05/22; 362969; P012
A dual-institutional study.
Dr. Alessia Fassari
Contributions
Contributions
Abstract
Aim:
The main causes for revisional bariatric procedures are weight regain (WR), inadequate weight loss, late complications, or loss of quality of life. In this dual-institutional study we aimed to evaluate results of redo surgery for partial failure (PF) and WR after primary bariatric surgery. Primary endpoints were represented by the weight loss after revision surgery expressed as percentage of excess weight loss (EWL) and its efficacy on the treatment of metabolic syndrome and its defining components.
Secondary endpoints included peri- and post-operative complications and 30-day mortality.
Materials and Methods: A retrospective analysis was conducted on prospectively collected database in two bariatric centers in Rome: San Giovanni Addolorata Hospital Complex and Villa San Pietro Fatebenefratelli Hospital.
From January 2003 to January 2020 a total of 130 patients underwent revisional laparoscopic surgery. While each patient may have had more than one indication to undergo revisional surgery, primary inadequate weight loss (< 50% EWL) at 1 year was the most common reason to qualify followed by weight recidivism (≥ 20% regaining of the weight lost).
In our study, all primary procedures requiring revisions were restrictive: either laparoscopic adjustable gastric banding (AGB) 87 cases (Group 1) or laparoscopic sleeve gastrectomy (SG) 38 cases (Group 2). Revisional surgery included conversion to SG, Roux-en-Y Gastric Bypass (RYGB), one anastomosis gastric bypass (OAGB) or duodenal switch (DS). Patients were grouped according to primary procedure and type of revision.
Results:
All revisional procedures proved to be effective both for PF/WR following AGB and SG. Some interesting differences were found. Bypass-type revisional procedures (functional procedures) are more effective compared to re-sleeve surgery (new restrictive procedures). Furthermore, functional procedures such as RYGB or OAGB achieve not only the highest but even the most constant weight loss over time. The impact on diabetes remission, dyslipidemia normalization, arterial hypertension, and sleep apnea is comparable.
Conclusions:
Laparoscopic revisional bariatric surgery is safe and effective although experienced bariatric and laparoscopic surgeons are required. Redo surgery by functional procedures provides the best balance of long term weight loss, resolution of complications related to the primary procedure with minimal rate of perioperative complications.
The main causes for revisional bariatric procedures are weight regain (WR), inadequate weight loss, late complications, or loss of quality of life. In this dual-institutional study we aimed to evaluate results of redo surgery for partial failure (PF) and WR after primary bariatric surgery. Primary endpoints were represented by the weight loss after revision surgery expressed as percentage of excess weight loss (EWL) and its efficacy on the treatment of metabolic syndrome and its defining components.
Secondary endpoints included peri- and post-operative complications and 30-day mortality.
Materials and Methods: A retrospective analysis was conducted on prospectively collected database in two bariatric centers in Rome: San Giovanni Addolorata Hospital Complex and Villa San Pietro Fatebenefratelli Hospital.
From January 2003 to January 2020 a total of 130 patients underwent revisional laparoscopic surgery. While each patient may have had more than one indication to undergo revisional surgery, primary inadequate weight loss (< 50% EWL) at 1 year was the most common reason to qualify followed by weight recidivism (≥ 20% regaining of the weight lost).
In our study, all primary procedures requiring revisions were restrictive: either laparoscopic adjustable gastric banding (AGB) 87 cases (Group 1) or laparoscopic sleeve gastrectomy (SG) 38 cases (Group 2). Revisional surgery included conversion to SG, Roux-en-Y Gastric Bypass (RYGB), one anastomosis gastric bypass (OAGB) or duodenal switch (DS). Patients were grouped according to primary procedure and type of revision.
Results:
All revisional procedures proved to be effective both for PF/WR following AGB and SG. Some interesting differences were found. Bypass-type revisional procedures (functional procedures) are more effective compared to re-sleeve surgery (new restrictive procedures). Furthermore, functional procedures such as RYGB or OAGB achieve not only the highest but even the most constant weight loss over time. The impact on diabetes remission, dyslipidemia normalization, arterial hypertension, and sleep apnea is comparable.
Conclusions:
Laparoscopic revisional bariatric surgery is safe and effective although experienced bariatric and laparoscopic surgeons are required. Redo surgery by functional procedures provides the best balance of long term weight loss, resolution of complications related to the primary procedure with minimal rate of perioperative complications.
Aim:
The main causes for revisional bariatric procedures are weight regain (WR), inadequate weight loss, late complications, or loss of quality of life. In this dual-institutional study we aimed to evaluate results of redo surgery for partial failure (PF) and WR after primary bariatric surgery. Primary endpoints were represented by the weight loss after revision surgery expressed as percentage of excess weight loss (EWL) and its efficacy on the treatment of metabolic syndrome and its defining components.
Secondary endpoints included peri- and post-operative complications and 30-day mortality.
Materials and Methods: A retrospective analysis was conducted on prospectively collected database in two bariatric centers in Rome: San Giovanni Addolorata Hospital Complex and Villa San Pietro Fatebenefratelli Hospital.
From January 2003 to January 2020 a total of 130 patients underwent revisional laparoscopic surgery. While each patient may have had more than one indication to undergo revisional surgery, primary inadequate weight loss (< 50% EWL) at 1 year was the most common reason to qualify followed by weight recidivism (≥ 20% regaining of the weight lost).
In our study, all primary procedures requiring revisions were restrictive: either laparoscopic adjustable gastric banding (AGB) 87 cases (Group 1) or laparoscopic sleeve gastrectomy (SG) 38 cases (Group 2). Revisional surgery included conversion to SG, Roux-en-Y Gastric Bypass (RYGB), one anastomosis gastric bypass (OAGB) or duodenal switch (DS). Patients were grouped according to primary procedure and type of revision.
Results:
All revisional procedures proved to be effective both for PF/WR following AGB and SG. Some interesting differences were found. Bypass-type revisional procedures (functional procedures) are more effective compared to re-sleeve surgery (new restrictive procedures). Furthermore, functional procedures such as RYGB or OAGB achieve not only the highest but even the most constant weight loss over time. The impact on diabetes remission, dyslipidemia normalization, arterial hypertension, and sleep apnea is comparable.
Conclusions:
Laparoscopic revisional bariatric surgery is safe and effective although experienced bariatric and laparoscopic surgeons are required. Redo surgery by functional procedures provides the best balance of long term weight loss, resolution of complications related to the primary procedure with minimal rate of perioperative complications.
The main causes for revisional bariatric procedures are weight regain (WR), inadequate weight loss, late complications, or loss of quality of life. In this dual-institutional study we aimed to evaluate results of redo surgery for partial failure (PF) and WR after primary bariatric surgery. Primary endpoints were represented by the weight loss after revision surgery expressed as percentage of excess weight loss (EWL) and its efficacy on the treatment of metabolic syndrome and its defining components.
Secondary endpoints included peri- and post-operative complications and 30-day mortality.
Materials and Methods: A retrospective analysis was conducted on prospectively collected database in two bariatric centers in Rome: San Giovanni Addolorata Hospital Complex and Villa San Pietro Fatebenefratelli Hospital.
From January 2003 to January 2020 a total of 130 patients underwent revisional laparoscopic surgery. While each patient may have had more than one indication to undergo revisional surgery, primary inadequate weight loss (< 50% EWL) at 1 year was the most common reason to qualify followed by weight recidivism (≥ 20% regaining of the weight lost).
In our study, all primary procedures requiring revisions were restrictive: either laparoscopic adjustable gastric banding (AGB) 87 cases (Group 1) or laparoscopic sleeve gastrectomy (SG) 38 cases (Group 2). Revisional surgery included conversion to SG, Roux-en-Y Gastric Bypass (RYGB), one anastomosis gastric bypass (OAGB) or duodenal switch (DS). Patients were grouped according to primary procedure and type of revision.
Results:
All revisional procedures proved to be effective both for PF/WR following AGB and SG. Some interesting differences were found. Bypass-type revisional procedures (functional procedures) are more effective compared to re-sleeve surgery (new restrictive procedures). Furthermore, functional procedures such as RYGB or OAGB achieve not only the highest but even the most constant weight loss over time. The impact on diabetes remission, dyslipidemia normalization, arterial hypertension, and sleep apnea is comparable.
Conclusions:
Laparoscopic revisional bariatric surgery is safe and effective although experienced bariatric and laparoscopic surgeons are required. Redo surgery by functional procedures provides the best balance of long term weight loss, resolution of complications related to the primary procedure with minimal rate of perioperative complications.
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