Outcomes in revisional bariatric surgery: a high-volume single institution experience.

Abstract

This study aims to evaluate outcomes of adjustable gastric band (AGB) conversion to sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB), SG conversion to RYGB and RYGB revision procedures. Patients undergoing secondary bariatric surgery between 2009 and 2017 were retrospectively identified from a prospective database. Primary outcomes were weight loss and improvement in comorbidities. For weight loss, percent of total body weight loss (%TWL) and percentage of excess BMI loss (%EBMIL) were included. Comorbidities included were hemoglobin A1C (HbA1C), cardiovascular risk (CV) and hypertension. 266 Secondary bariatric procedures were analyzed. There were four Grade IIIb complicationswithin 30days. There was greater %EBMIL at 12 and 24months in the AGB to RYGB group, and in %TWL at 24months compared to AGB to SG group (p < 0.05). Only AGB to RYGB had significantly continued improvement in these two parameters at 24months compared to at 6months post-operatively-%EBMIL and %TWL tapered off in the other procedures. There was significantly lower CV risk in dyslipidemic patients at 24months in the AGB to RYGB compared to the AGB to SG group. In the SG to RYGB patients, there was significant improvement in CV risk in dyslipidemic patients at 24months compared to baseline. There was significant improvement in HbA1C in diabetics in AGB to RYGB patients at 6 and 12months, in AGB to SG patients at 12months, and in SG to RYGB patients at 12 and 24months compared to baseline. In RYGB revision and SG to RYGB patients, there was a relative increase in the number of patients being normotensive at 24months compared to baseline. Secondary bariatric surgery is a complex and challenging procedure that may improve weight loss and cardiovascular risk for certain procedures but further studies will be necessary.