Laparoscopic Reoperative Bariatric Surgery: Experience from 27 Consecutive Patients

Gautier, Michel; Gentileschi, Paolo; Csepel, John de; Kini, Subhash; Patterson, Emma; Inabnet, William B.; Herron, Daniel M.; Pomp, Alfons

doi:10.1381/096089202762552737

Cited by 175 publications

(87 citation statements)

References 22 publications

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“…Several studies have reported pre-and postopera tive BMI results similar to ours. [14][15][16] Half of all revision patients had a prior VBG. Because of resultant complications and poor weight loss (21%-50%), this procedure was phased out as a primary bariatric procedure many years ago.…”

Section: Discussionmentioning

confidence: 99%

A comparison of revisional and primary bariatric surgery

Fulton

Sheppard

Birch

et al. 2017

CJS

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A comparison of revisional and primary bariatric surgeryBackground: Revisional surgery is an important component of addressing weight regain and complications following primary bariatric surgery. Owing to provincial need and the complexity of this patient population, a specialized multidisciplinary revision clinic was developed. We sought to characterize patients who undergo revision surgery and compare their outcomes with primary bariatric surgery clinic data. Methods:We completed a retrospective chart review of bariatric revision clinic patients compared with primary bariatric surgery patients from December 2009 to June 2014. Results:We reviewed the charts of 2769 primary bariatric clinic patients, 886 of whom had bariatric surgery, and 534 revision bariatric clinic patients, 83 of whom had revision surgery. Fewer revision clinic patients underwent surgery than primary clinic patients (22% v. 32%). The mean preoperative body mass index (BMI) was 44.7 ± 9.5 in revision patients compared with 45.7 ± 7.6 in primary bariatric surgery patients. Most revision patients had a prior vertical banded gastroplasty (VBG; 48%) or a laparoscopic adjustable gastric band (LAGB; 24%). Bands were removed in 36% of all LAGB patients presenting to clinic. Of the 134 procedures performed in the revision clinic, 83 were bariatric weight loss surgeries, and 51 were band removals. Revision clinic patients experienced a significant decrease in BMI (from 44.7 ± 9.5 to 33.8 ± 7.5, p < 0.001); their BMI at 12-month follow-up was similar to that of primary clinic patients (34.5 ± 7.0, p = 0.7). Complications were significantly more frequent in revision patients than primary patients (41% v. 15%, p < 0.001). Conclusion:A bariatric revision clinic manages a wide variety of complex patients distinct from those seen in a primary clinic. Operative candidates at the revision clinic are chosen based on favourable medical, anatomic and psychosocial factors, keeping in mind the resource constraints of a public health care system. Contexte : La chirurgie de révision est une intervention importante lors d'une reprise de poids ou lors de complications à la suite d'une chirurgie bariatrique primaire. Compte tenu des besoins provinciaux et de la complexité de cette population de patients, une clinique de révision multidisciplinaire spécialisée a été créée. Nous avons voulu caractériser les patients qui subissent une chirurgie de révision et comparer leurs résultats aux données de la clinique de chirurgie bariatrique primaire.Méthodes : Nous avons procédé à un examen rétrospectif des dossiers des patients de la clinique de révision bariatrique par rapport aux patients ayant subi une chirurgie bariatrique primaire entre décembre 2009 et juin 2014.Résultats : Nous avons examiné les dossiers de 2769 patients de la clinique bariatrique primaire, dont 886 avaient subi une chirurgie bariatrique, et 534 patients de la clinique de révision, dont 83 avaient subi une chirurgie de révision. Un moins grand nombre de patients de la clinique de révision ont subi une c...

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Section: Discussionmentioning

confidence: 99%

A comparison of revisional and primary bariatric surgery

Fulton

Sheppard

Birch

et al. 2017

CJS

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“…Failure is commonly defined as inadequate weight loss and constitutes the primary indication for revisions in most series dealing with revisional bariatric surgery [7,10]. Consensus is that inadequate weight loss is diagnosed in cases where 50% excessive weight loss (EWL) or a BMI <35 is not achieved or maintained in the long term [11].…”

Section: Indications For Reoperationsmentioning

confidence: 99%

“…However, the success rate of the different available operative techniques is not 100%, and failures do occur during follow-up. About 10-25% of patients undergoing bariatric surgery require revisional surgery, mainly due to insufficient weight loss or due to complications from the primary procedure [7,8]. Revisional bariatric surgery can be complex and technically demanding depending on the primary operation and on the indication leading to reoperation.…”

Section: Introductionmentioning

confidence: 99%

Operative Strategies for Patients with Failed Primary Bariatric Procedures

Buhmann

Vines²,

Schiesser³

2014

Dig Surg

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Bariatric surgery is the most effective therapy to treat obesity and its sequelae. With the increasing incidence of obesity, the number of bariatric procedures has dramatically increased in recent years. The perioperative morbidity reached a very low level, and nearly all revisional bariatric procedures are primarily minimally invasive today. About 10-25% of the patients undergoing bariatric surgery require a revision at some point after their initial operation. Consequently, revisional bariatric surgery has emerged as a distinct practice, performed mainly at tertiary centers, to resolve complications caused by the primary operation and to provide satisfactory weight loss. In this review, our personal experience with revisional bariatric surgery is discussed against the background of the available literature. We further attempt to define major indications for revisional bariatric surgery and balance them with perioperative and long-term morbidity as well as the surgical outcome.

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“…3 Up to 12% of patients will have some type of surgical revision following gastric bypass surgery due to weight gain or postoperative symptoms related to stomal dilation. 4 Reoperation can present significant technical challenges to the surgeon and result in appreciable morbidity or mortality. 5 Patients who undergo operative revision have a lengthy operation, a major complication rate of 14%, and a mortality rate of 1.3%.…”

Section: Introductionmentioning

confidence: 99%