Comparing the Effectiveness of Different Types of Revisional Bariatric Surgery on Weight Loss

Abstract

INTRODUCTION: Although Roux-en-Y gastric bypass (RYGB) is one of the most effective weight loss operations, 10% to 35% of patients fail to lose weight. This population may benefit from revisional operation; however, no standardized approach currently exists. This study examines weight loss after various methods of RYGB revisional operation. METHODS: MBSAQIP and retrospective chart review were used to identify patients who underwent revisional RYGB operation at a single, high-volume institution between 2014 and 2021. Revisional procedures were categorized as gastric pouch and/or gastrojejunal anastomosis revision (PAR), distalization of jejunojejunal anastomosis only (DJA), or pouch/GJA revision and distalization (PAD). Demographics, preoperative comorbidity, weight loss, and 30-day complication were compared among groups. RESULTS: A total of 193 patients underwent revisional bariatric surgery due to insufficient weight loss. Of these, 138 (71.5%) underwent PAR, 8 (4.15%) had DJA, and 47 (24.35%) had PAD. No significant differences were found in sociodemographic factors; preoperative weight, BMI, or comorbidity; and 30-day postoperative complication, emergency department visits, and readmission rate. All 3 methods have led to a statistically significant decrease in BMI (p < 0.0001 for PAR and PAD, p = 0.001 for DJA) and weight (p < 0.0001 for PAR and PAD, p = 0.002 for DJA), but there were no significant differences in excess BMI and weight loss among the 3 methods (Table 1). Table 1. - Comparing Preoperative Measurements and Postoperative Outcomes among 3 RYGB Revision Procedures Characteristic Pouch and/or GJA resizing (PAR) Distalization only (DJA) Pouch/GJA resizing and distalization (PAD) p Value Preoperative BMI (kg/m2) 43.15 (SD = 7.59) 44.57 (SD = 4.90) 43.67 (SD = 6.13) 0.807 Current BMI (kg/m2) 39.6 (SD = 11.1) 39.3 (SD = 4.3) 39.0 (SD = 7.9) 0.937 Preoperative weight (kg) 116.0 (SD = 24.0) 116.7 (SD = 16.7) 117.2 (SD = 18.9) 0.945 Current weight (kg) 104.4 (SD = 22.9) 104.3 (SD = 13.6) 100.7 (SD = 19.2) 0.596 Emergency department visits within 30 days postoperatively 6 (4.35%) 0 (0%) 2 (4.26%) 0.225 Readmission within 30 days postoperatively 9 (6.5%) 9 (6.5%) 3 (6.38%) 0.490 Excess BMI loss (%) 28.5 (SD = 68.2) 26.8 (SD = 12.7) 25.5 (SD = 30) 0.956 Weight loss (%) 8.75 (SD = 17) 10.4 (SD = 5.5) 13.5 (SD = 12.5) 0.205 Length of stay (days) 1.7 (SD = 0.9) 1.3 (SD = 0.5) 1.5 (S D= 0.8) 0.175 CONCLUSION: Revisional bariatric surgery is effective in leading to weight loss, but there is no significant difference in the effectiveness of the 3 methods. We plan to compare the 3 methods in terms of long-term complication and resolution of comorbidity.