How Good is Stratification and Prediction Model Analysis Between Primary and Revisional Roux-en-Y Gastric Bypass Surgery? A Multi-center Study and Narrative Review

Abstract

Introductions Revision surgery because of weight recurrence is performed in 2.5–33% of primary vertical banded gastroplasty (VBG), laparoscopic sleeve gastrectomy (LSG), and gastric band (GB) cases. These cases qualify for revisional Roux-en-Y gastric bypass (RRYGB). Methods This retrospective cohort study analyzed data from 2008 to 2019. A stratification analysis and multivariate logistic regression for prediction modeling compared the possibility of sufficient % excess weight loss (%EWL) ≥ 50 or insufficient %EWL < 50 between three different RRYGB procedures, with primary Roux-en-Y gastric bypass (PRYGB) as the control during 2 years of follow-up. A narrative review was conducted to test the presence of prediction models in the literature and their internal and external validity. Results A total of 558 patients underwent PRYGB, and 338 underwent RRYGB after VBG, LSG, and GB, and completed 2 years of follow-up. Overall, 32.2% of patients after RRYGB had a sufficient %EWL ≥ 50 after 2 years, compared to 71.3% after PRYGB (p ≤ 0.001). The total %EWL after the revision surgeries for VBG, LSG, and GB was 68.5%, 74.2%, and 64.1%, respectively (p ≤ 0.001). After correcting for confounding factors, the baseline odds ratio (OR) or sufficient %EWL ≥ 50 after PRYGB, LSG, VBG, and GB was 2.4, 1.45, 0.29, and 0.32, respectively (p ≤ 0.001). Age was the only significant variable in the prediction model (p = 0.0016). It was impossible to develop a validated model after revision surgery because of the differences between stratification and the prediction model. The narrative review showed only 10.2% presence of validation in the prediction models, and 52.5% had external validation. Conclusion Overall, 32.2% of all patients after revisional surgery had a sufficient %EWL ≥ 50 after 2 years, compared to PRYGB. LSG had the best outcome in the revisional surgery group in the sufficient %EWL group and the best outcome in the insufficient %EWL group. The skewness between the prediction model and stratification resulted in a partially non-functional prediction model. Graphical Abstract

Revision of restrictive bariatric procedures in elderly patients: results at a 5-year follow-up

“…Although not statistically significant, LAGB revisions had nearly significant higher TWL outcomes compared to SG revisions (TWL 24.1% vs 16.5%; p = 0.08). This is similar to previous reports on revisions after LAGB and SG-with SG revisions trailing LAGB revisions regarding weight loss outcomes [17,19]. TWL < 20% was considered a poor clinical response and this was seen in 30% of patients which is reasonable when considering it from the revision date and in our opinion is only one of the markers determining the outcome postoperatively.…”

“…Our study suggests that RBS is associated with a reasonable complication rate in the elderly population. We had only three patients with significant complications (CD > = 3) (7.7%), which is similar to the complication rates reported in previous reports on revisional bariatric surgeries on younger candidates [17]. Although patients s/p SG undergoing revisional surgery had a 12.5% major complication rate compared to 4.3% in s/p LAGB, this did not reach statistical significance due to the small sample size, in addition it is difficult to draw clear conclusions from this relatively small cohort.…”

Revisional One-Step Bariatric Surgical Techniques After Unsuccessful Laparoscopic Gastric Band: A Retrospective Cohort Study with 2-Year Follow-up

“…Moreover, in a recent study, rOAGB showed significantly higher %EWL than rLSG at 2 (70.4% vs. 55.6%) and 4 years (68.7% vs. 54.6%) [ 31 ]. A 2023 study [ 32 ] delineated a noticeable difference between primary RYGB and revisional RYGB post-LAGB, with significantly lower %EWL (93.7 vs. 64.1%) and %TWL (47.3% vs. 24.6%) after 2 years. However, it is to be noted that this outcome was exclusively observed in revisional RYGB procedures.…”

The Relationship between Depressive Symptoms, Quality of Life and miRNAs 8 Years after Bariatric Surgery

“…Revisional RYGB is commonly employed to revise bariatric procedures due to insufficient WL or weight recurrence. However, despite this, only one third of all the patients undergoing revisional surgery had a sufficient %EWL after 2 years compared with primary RYGB [11].…”

“…BS is considered a successful intervention when the outcome of the surgery is the loss of ≥50% of the percentage of excess weight (%EWL), which is related to decreasing the risk of developing obesity-related diseases [5]. This index is widely used, even in recent studies [6][7][8][9][10], including reviews on this topic [11][12][13], to analyse the efficacy of bariatric surgery on weight loss. However, there is still a high percentage of failure (up to 50%), since the efficacy of the procedure depends on many factors, such as type of procedure, age, sex and ethnic background [14].…”