A Retrospective Comparative Study of Primary Versus Revisional Roux-en-Y Gastric Bypass: Long-Term Results

Mar 11, 2018Obesity surgery

Long-Term Outcomes of First-Time Versus Repeat Roux-en-Y Gastric Bypass Surgery

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Abstract

A total of 342 laparoscopic gastric bypass operations were analyzed, with 245 classified as primary and 97 as revisional.

Mean preoperative body mass index (BMI) was 45.2 for primary and 41.1 for revisional gastric bypass patients.
Median operative time was significantly longer for revisional procedures at 235 minutes compared to 157.5 minutes for primary procedures.
Length of hospital stay was slightly longer for revisional gastric bypass patients, averaging 6.5 days compared to 6 days for primary patients.
The conversion to open surgery occurred in 0.4% of primary cases and 7.2% of revisional cases.
Morbidity rates were 6.5% for primary and 10% for revisional procedures, with no significant statistical difference.
The percentage of excess BMI loss was significantly lower in the revisional group at 12, 18, and 24 months of follow-up.

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AIMS: To compare the perioperative parameters and excess weight loss between patients operated by laporoscopic Roux-en-Y gastric bypass (LRYGB), as a primary operation or a revisional, for insufficient weight loss after vertical banded gastroplasty (VBG) or adjustable gastric banding (AGB).

METHODS: A retrospective analysis of all patients who underwent a LRYGB was performed for the period 2004-2011. Demographics, preoperative body mass index (BMI), co-morbidities, operation time, conversion rate, perioperative complications, hospitalization period, and % of excess BMI loss (%EBMIL) were investigated and compared between groups.

RESULTS: Three hundred forty-two laparoscopic gastric bypass operations were performed, 245 were primary, and 97 revisional. Median follow-up was 30 months (range 0-108 months). Mean BMI (kg/m) before bypass was 45.2 for primary laparoscopic Roux-en-Y gastric bypass (pLRYGB) and 41.1 for revisional laparoscopic Roux-en-Y gastric bypass (rLRYGB). Median operative time and length of stay were longer for rLRYGB 157.5 versus 235 min (p < 0.001) and 6 versus 6.5 days (p = 0.05). Conversion to laparotomy was performed in eight patients, 0.4% of primary and 7.2% of revisional. Morbidity rate was 6.5% in pLRYGB versus 10% in rLRYGB (NS). There was one death in the primary group. Percentage of EBMIL was significantly lower in the revisional group at 12, 18, and 24 months of follow-up. 2

CONCLUSIONS: Revisional and primary gastric bypass have no statistical differences in terms of morbidity. The % of excess BMI loss is lower after revisional gastric bypass during the first 2 years of follow-up. The trend of weight loss or weight regain was similar in both groups.

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A Retrospective Comparative Study of Primary Versus Revisional Roux-en-Y Gastric Bypass: Long-Term Results

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