IBC-Oxford University2023_BJSOral_27Trends and Safety of Bariatric Revisional Surgery in Italy: multi-centre, prospective, observational study

Abstract

Abstract Introduction Revisional bariatric surgery (RBS) represents a further solution for patients who experience inadequate weight loss (IWL) following primary bariatric surgery (BS) or significant weight regain (WR) following initial satisfactory response. RBS guidelines are lacking, however, an increased trend in further BS offering has been reported lately. Objectives Analysing trend, mortality, complication, readmission, and reoperation rates for any reason at 30 days after RBS in Italy. Setting: 10 Italian high-volume bariatric surgery centres (University hospitals and Private centres). Methods Prospective, observational, multi-centre study enrolling patients undergoing RBS between 01.10.2021-31.03.2022, registering reasons for RBS, technique, mortality, intraoperative and perioperative complications, readmissions, and reinterventions for any reason. Patients undergoing RBS during same calendar interval of 2016-2020 were considered control-group. Results 220 patients were enrolled and compared with 560 control-group patients. Mortality was 0.45% vs 0.35% (not significant), with an overall of 0.25%, while open surgery or conversion to open surgery registered in 1%. No difference was found for mortality, morbidity, complications, readmission (1.3%) and reoperation rates (2.2%). IWL/WR was the most frequent cause, followed by GERD; Roux-en-Y gastric bypass (RYGB) was the most used revisional procedure (56%). Sleeve gastrectomy (SG) was the most revised procedure in the study-group, while gastric banding in the control-group. RBS represents up to 9% of the total BS in the Italian participating centres. Conclusions Laparoscopy represents the standard approach for RBS, which appears safe. Current Italian trends show a shift towards SG being the most revised procedure and RYGB the most used as revisional procedure.