Secondary Bariatric Procedures in a High-Volume Centre: Prevalence, Indications and Outcomes.

Abstract

Secondary bariatric procedures represent a challenge to both patients and surgeons. The objective of this study was to explore the patterns of recurrence and modalities of secondary bariatric procedures in a tertiary bariatric centre. A retrospective analysis of patients who underwent secondary bariatric procedures after laparoscopic adjustable gastric band (AGB), sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) from April 2007 to March 2017. Overall, 3266 bariatric procedures were performed, and secondary bariatric procedures were required for 45 (1.4%) patients (28 AGB, 14 SG, 3 RYGB). Twenty-six (57.8%) patients underwent conversion to RYGB, eight (17.8%) patients underwent conversion to SG, seven (15.6%) patients were converted to duodenal switch (DS), two (4.4%) patients had revision of gastrojejunal anastomosis, one (2.2%) patient underwent revision of gastric pouch and one (2.2%) patient had replacement of AGB. Mean change in BMI and %TWL at 18months were 8.5 ± 3.9kg/m2 and 17.6 ± 8.2 respectively after revision of AGB. Mean change in BMI and %TWL at 18months were 11.7 ± 11.2kg/m2 and 18.4 ± 13.2 respectively after revision of SG. Mean change in BMI and %TWL at 18months were 2.6 ± 3.0kg/m2 and 6.9 ± 6.8 respectively after revision of RYGB. No mortality was reported after revision procedures. Weight regain, inadequate weight loss and reflux were the main reasons for performing secondary bariatric procedures. The main revision procedures performed were RYGB and SG especially for failed AGB.