Postoperative morbidity and weight loss after revisional bariatric surgery for primary failed restrictive procedure: A systematic review and network meta-analysis

May 19, 2022International journal of surgery (London, England)

Complications and weight loss after follow-up weight-loss surgery when the first restrictive surgery didn’t work: A review and comparison of options

AI simplified

GLP-1 Therapies on OpenScience ↗PubMed ↗DOI ↗

Abstract

Biliopancreatic diversion with duodenal switch achieves the highest weight loss outcomes, with a 12.38% and 28.42% total weight loss at 1 and 3 years respectively.

Single-anastomosis duodenoileal bypass follows with 9.24% and 19.13% total weight loss at 1 and 3 years.
One-anastomosis gastric bypass and Roux-en-Y gastric bypass demonstrate lower weight loss outcomes of 7.16% and 13.1%, and 4.68% and 7.3%, respectively.
Duodenal switch and Roux-en-Y gastric bypass are linked to a higher risk of late major complications, with odds ratios of 3.07 and 2.11.
Re-sleeve gastrectomy is the revisional procedure most commonly associated with weight regain.
Patients undergoing single-anastomosis duodenoileal bypass have a significantly lower risk of weight recidivism, with an odds ratio of 0.07.

AI simplified

BACKGROUND: revisional bariatric surgery is gaining increasing interest as long term follow-up studies demonstrate an elevated failure rate of primary surgery due to insufficient weight loss, weight regain or complications. This particularly concerns restrictive bariatric surgery which has been widely adopted from the '80s till present through different procedures, notably vertical banded gastroplasty, laparoscopic adjusted gastric banding and sleeve gastrectomy. The aim of this study is to define which revisional bariatric procedure performs the best after failure of primary restrictive surgery.

METHODS: a systematic review and network meta-analysis of 39 studies was conducted following the PRISMA guidelines and the Cochrane protocol.

RESULTS: biliopancreatic diversion with duodenal switch guarantees the best results in terms of weight loss (1 and 3-years %TWL MD: 12.38 and 28.42) followed by single-anastomosis duodenoileal bypass (9.24 and 19.13), one-anastomosis gastric bypass (7.16 and 13.1), and Roux-en-Y gastric bypass (4.68 and 7.3) compared to re-sleeve gastrectomy. Duodenal switch and Roux-en-Y gastric bypass are associated to an increased risk of late major morbidity (OR: 3.07 and 2.11 respectively) compared to re-sleeve gastrectomy while no significant difference was highlighted for the other procedures. Re-sleeve gastrectomy is the revisional intervention most frequently burdened by weight recidivism; compared to it, patients undergoing single-anastomosis duodenoileal bypass have the lowest risk of weight regain (OR: 0.07).

CONCLUSION: considering the analyzed outcomes altogether, single-anastomosis duodenoileal bypass and one-anastomosis gastric bypass are the most performing revisional procedures after failure of restrictive surgery due to satisfying short and mid-term weight loss and low early and late morbidity. Moreover, single-anastomosis duodenoileal bypass has low risk of weight recidivism.

Full Text

Full text is available at the source.

View full text (XML) ↗View full text ↗

Postoperative morbidity and weight loss after revisional bariatric surgery for primary failed restrictive procedure: A systematic review and network meta-analysis

Abstract

Full Text

You found one interesting study. We’ll send the next 7.

what lands in your inbox each week:

Recent issues from the glp-1 therapies brief

Abstract

Full Text

Related papers

You found one interesting study. We’ll send the next 7.

what lands in your inbox each week:

Recent issues from the glp-1 therapies brief