Revisional Bariatric Surgery for Insufficient Weight Loss and Gastroesophageal Reflux Disease: Our 12-Year Experience.

Abstract

Although bariatric surgery is increasing in Japan, revision surgery is uncommon. To clarify indications for the various revision surgeries available, we retrospectively assessed perioperative/postoperative outcomes of revisional weight loss surgeries performed at our medical center between July 2006 and July 2017. The study group comprised patients treated for insufficient weight loss (IWL group, n = 15) or intractable postoperative gastroesophageal reflux disease (GERD group, n = 9). Clinical characteristics and perioperative/postoperative outcomes were assessed for the total patients, per patient group, and per type of revision surgery performed. In the IWL group, BMI decreased from 47.3 ± 9.2kg/m2 at the time of revision surgery to 36.9 ± 7.4kg/m2 1year later, and excess weight loss (%EWL) reached 62.7 ± 14.6%. Among patients whose primary surgery was laparoscopic sleeve gastrectomy, %EWL and total weight loss (%) were greater after laparoscopic biliopancreatic diversion with duodenal switch (LBPD/DS) or duodenojejunal bypass (DJB) than after other revision surgeries. Complete or partial remission of the GERD was achieved in all GERD group patients (9/9, 100%), and six (6/9, 66.7%) were able to discontinue proton pump inhibitor therapy. Serious complications occurred in four patients (4/24, 16.7%) following laparoscopic Roux-en-Y gastric bypass (LRYGB): stump leakage in one, gastrojejunal leak in one, and gastrojejunal stricture in two. LBPD/DS or DJB as revision surgery appears to be effective for further weight loss in the medium term, and LRYGB appears to be effective for GERD remission. Bariatric surgeons should bear in mind, however, that the post-LRYGB complication rate appears to be relatively high.