Incidence and Indications for Revisional Metabolic Bariatric Surgery: A 10-Year Analysis from the Australian and New Zealand Registry.

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To determine the incidence, timing, type, and indications for revisional surgery (defined as any operation performed after primary MBS up to 10y). Understanding long-term reoperation rates is essential for patient counselling and service planning in metabolic bariatric surgery (MBS). While primary MBS is well established as the most effective treatment for severe obesity, revisional procedures are increasingly required due to weight regain, complications or intolerance of the index procedure. However, high-quality population-level data on revision risk after metabolic bariatric surgery is limited. We conducted a retrospective cohort study using prospectively collected data from the Australian and New Zealand Bariatric Surgery Registry. Patients undergoing primary MBS on or before December 31, 2023, were followed for up to 10 years. Kaplan-Meier analysis was conducted. 145,193 patients (median age 42 (IQR 33-50) years 78.7% female) underwent primary MBS. Over a median 5.6y (IQR 2.9-8.1), 5,681 patients (4%) underwent a first revisional surgery (7.3 per 1,000 person-years; 95% CI, 7.1-7.4). The observed incidence was highest after AGB (28.7%; 46.7% reversals), followed by RYGB (4.8%; 94.8% corrective), OAGB (3.5%; 52.7% corrective) and SG (2.5%; 69.6% conversions). AGB revisions were mostly due to recurrent weight gain (13.3%) and port-related issues (12.7%); reflux was the most common reason after SG (29.1%) and OAGB (27.3%), while strictures were the most frequent indication following RYGB (23.4%). Incidence, type, and indication of revisional procedures differ from those of the primary procedure. These findings may guide patient decision-making and health system planning.