Weight Loss Outcome of Revisional Bariatric Operations Varies According to the Primary Procedure

Jul 25, 2008Annals of surgery

Weight loss results after follow-up weight loss surgery depend on the first surgery type

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Abstract

Mean weight loss after revision of primary operations was 90 pounds for jejunoileal bypass, 113 pounds for gastroplasty/banding, and 71 pounds for gastric bypass.

Primary operations included jejunoileal bypass, gastroplasty/banding, and gastric bypass, with various types of revisions performed.
Perioperative morbidity and mortality rates were 21.8% and 1.3%, respectively.
At 12 months follow-up, 93% of patients were assessed for weight loss outcomes.
Mean percent of excess weight loss was 51% after jejunoileal bypass, 56% after gastroplasty/banding, and 48% after gastric bypass.
Improvement or resolution of comorbidities occurred in 100% of patients who lost 50% or more of their excess weight.

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BACKGROUND: Revisional bariatric operations performed for weight loss failure are frequently associated with inconsistent weight reduction and serious perioperative complications.

METHODS: Outcomes of 151 consecutive revisional operations performed by one surgeon for unsatisfactory weight loss were compared to determine whether postoperative weight loss is influenced by the type of primary procedure. Minimum follow-up was 12 months.

RESULTS: Primary operations included 14 jejunoileal bypass (JIB): one revised to gastroplasty, 13 to RY gastric bypass; 71 gastroplasty/banding (GP/B): all revised to Roux-en-Y gastric bypass (RYGB); and 66 gastric bypass: 49 revised to distal/malabsorptive RYGB, 12 restapled without malabsorption, and 5 loop bypasses revised to standard RYGB. Perioperative morbidity/mortality rates were 21.8% and 1.3%, respectively. Follow-up at 12 months was 93%. Mean weight/body mass index unit loss after revision of JIB was 90 pounds/17 units versus 113 pounds/16 units after revision of GP/B and 71 pounds/11 units after revision of gastric bypass (P < or = 0.05) with corresponding mean percent of excess weight loss of 51% for JIB, 56% for GP/B, and 48% for gastric bypass. Five of the JIB revisions (38%) lost > or = 50% excess weight loss versus 39 of the GP/B revisions (61%) and 28 of the gastric bypass revisions (48%). Comorbidities improved/resolved in 100% of those who lost > or = 50% of excess weight versus 89% who did not.

CONCLUSIONS: Weight loss after revision of pure restrictive operations is significantly better than after revision of operations with malabsorptive components. Improvement of comorbidities in the great majority of patients justifies revision of all types of bariatric operations for unsatisfactory weight loss.

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Weight Loss Outcome of Revisional Bariatric Operations Varies According to the Primary Procedure

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