Revisional Bariatric Procedures Research Articles

Challenges of Revisional Metabolic and Bariatric Surgery: A Comprehensive Guide to Unraveling the Complexities and Solutions of Revisional Bariatric Procedures.

Revisional metabolic and bariatric surgery (RMBS) presents unique challenges in addressing weight loss failure or complications arising from initial bariatric procedures. This review aims to explore the complexities and solutions associated with revisional bariatric procedures comprehensively, offering insights into the evolving terrain of metabolic and bariatric surgery. A literature review is conducted to identify pertinent studies and expert opinions regarding RMBS. Methodological approaches, patient selection criteria, surgical techniques, preoperative assessments, and postoperative management strategies are synthesized to provide a comprehensive overview of current practices and advancements in the field, including institutional protocols. This review synthesizes key findings regarding the challenges encountered in RMBS, including the underlying causes of primary procedure failure, anatomical complexities, technical considerations, and assessments of surgical outcomes. Additionally, patient outcomes, complication rates, and long-term success are presented, along with institutional approaches to patient assessment and procedure selection. This review provides valuable insights for clinicians grappling with the complexities of RMBS. A comprehensive understanding of patient selection, surgical techniques, preoperative management, and postoperative care is crucial for enhancing outcomes and ensuring patient satisfaction in the field of metabolic bariatric surgery.

Five-year outcomes of revisional bariatric surgery: gastric band to sleeve gastrectomy or to Roux-en-Y gastric bypass.

Revisional bariatric surgery after an index adjustable gastric band (AGB) may be indicated to remedy weight relapse or band-related complications. We examined outcomes five years following revision from AGB to laparoscopic sleeve gastrectomy (AGB-LSG) or to Roux-en-Y gastric bypass (AGB-RYGB). We conducted a retrospective review to identify patients (men and women, age 18-80) who underwent one revisional bariatric procedure with AGB as the index procedure at two medical centers in our healthcare system between January 2012 and February 2017. We only included patients with a pre-revision BMI > 30kg/m2 for whom 5-year follow-up data were available. We compared 5-year weight loss and remission of comorbidities in patients undergoing AGB-LSG and AGB-RYGB conversion. A total of 114 patients met inclusion criteria (65 AGB-LSG, 49 AGB-RYGB). At 5-year post-revision, percent total weight loss (3.4% vs 19.9%; p < 0.001), percent excess weight loss (7.0% vs 50.8%; p < 0.001) and decrease in BMI (1.5 vs 8.8; p < 0.001) was greater in AGB-RYGB vs. AGB-LSG. No significant difference in remission or development of new comorbidities was observed. Conversion of AGB to RYGB is associated with superior intermediate-term weight loss compared to conversion of AGB to LSG. Future multicenter studies with larger sample sizes are necessary to further describe the intermediate-term outcomes of revisional bariatric surgery.

Efficacy of Bowel Regimen in Decreasing Postoperative Constipation in Bariatric Surgery Patients.

Postoperative constipation after bariatric surgery is a common complaint, decreasing patient quality of life. No literature exists examining the efficacy of a preoperative bowel regimen in reducing postoperative constipation in this cohort. This study aims explore the efficacy of a well-established bowel regimen, polyethylene glycol (PEG), in reducing constipation frequency and severity after bariatric surgery. This was a retrospective study of adult patients undergoing primary and revisional bariatric procedures. The use of PEG bowel prep for bariatric patients was introduced as an institutional quality improvement measure. Patients during the first 3months after PEG implementation were surveyed for postoperative constipation. For the year after implementation, patients were followed for 30-day emergency room visits or hospitalization secondary to constipation. This cohort was compared to historical controls from the previous year. Student t-tests were used for statistical analysis. During the 3-month exploratory phase, 28/49 (57.14%) patients fully completed the bowel regimen. In total, 0/56 (0%) patients reported preoperative constipation, and 5/28 (17.9%) patients reported constipation at the 3-week follow-up. In the 1year post-implementation cohort, 2/234 (0.85%) patients had constipation-related occurrences at 30-day follow-up, compared to 8/219 patients (3.65%) in the historical cohort (p = 0.04). The implementation of a PEG-based bowel regimen did not eliminate self-reported constipation. However, there were significant differences in rates of constipation-related ED visits and hospital readmissions, suggesting that the bowel regimen decreases rates of severe constipation. Finally, patient compliance was limited. Future work should aim towards increasing compliance.

IBC-Oxford University2023_BJSOral_20Video Presentation: Fundectomy and Indocyanine green fluorescence angiography in revisional laparoscopic Roux-en-Y gastric bypass

Abstract Introduction Revisional bariatric procedures are increasingly prevalent. These procedures are more complex with higher risk of complications as compared to primary procedures. The potential indications for revisional laparoscopic gastric bypass (R-LRYGB) may include weight regain and gastroesophageal reflux disease (GORD). This video abstract presents role of fundectomy and Indocyanine green fluorescence angiography (ICG-FA) for perfusion assessment of gastric pouch in R-LRYGB. Methods and Operative technique A 40-year-old female with previous laparoscopic adjustable gastric band (LAGB) surgery underwent R-LRYGB procedure following approval at bariatric multidisciplinary team meeting. LAGB was removed due to band slippage and chronic pouch dilatation, 2 years prior to the revisional procedure. Preoperative BMI was 53 kg/m2. Pre-operative upper gastrointestinal endoscopy was normal. The operative technique included dissection of angle of His, access into lesser sac along lesser curve below 2nd vessel off left gastric artery (LGA) and division of short gastric vessels to gain access to leaser sac from lateral aspect. The stomach was divided horizontally with linear stapler (EndoGIA 60 Gold cartridge), level with second vessel off LGA followed by creation of vertical gastric pouch over a size 34 Oro-gastric tube, that included excision of gastric fundus. ICG was administered intravenously according to an agreed protocol for the study. Karl Storz Image1 STM Rubina system with overlay and monochromatic modes was used for perfusion assessment. ICG-FA was utilised for qualitative assessment of gastric pouch perfusion before and after linear stapled gastro-jejunal anastomosis. Results Operative time was 240 minutes. Adhesions were encountered in the lesser sac at the site of previous LAGB. Fundectomy allowed better visualisation of lesser sac, adhesiolysis and facilitated creation of gastric pouch. ICG perfusion of gastric pouch was satisfactory. The postoperative length of stay was 2 days. There were nopostoperative complications at 6 months follow-up. The patient achieved 42% excess weight loss (BMI 43) over 6 months period. Conclusions Fundectomy is a safe and feasible operative step in R-LRYGB in patients with previous primary LAGB. ICG-FA is a promising qualitative assessment tool in revisional bariatric procedures.

Roux-en-Y gastric bypass and sleeve gastrectomy as revisional bariatric procedures after adjustable gastric banding: a retrospective cohort study

IntroductionThe frequency of revisional bariatric surgery is increasing, but its effectiveness and safety are not yet fully established. The aim of our study was to compare short-term outcomes of primary (pRYGB and pSG) and revisional bariatric surgeries (rRYGB and rSG).MethodsWe performed a retrospective cohort study assessing all patients submitted to primary and revisional (after a failed AGB) RYGB and SG in 2019. Each patient was followed-up at 6 months and 12 months after surgery. We compared pRYGB vs. rRYGB, pSG vs. rSG and rRYGB vs. rSG on weight loss, surgical complications, and resolution of comorbidities.ResultsWe assessed 494 patients, of which 18.8% had undergone a revisional procedure. Higher weight loss at 6 and 12 months was observed in patients undergoing primary vs. revisional procedures. Patients submitted to rRYGB lost more weight than those with rSG (%EWL 12 months = 82.6% vs. 69.0%, p < 0.001). Regarding the resolution of obesity-related comorbidities, diabetes resolution was more frequent in pRYGB than rRYGB (54.2% vs. 25.0%; p = 0.038). Also, 41.7% of the patients who underwent rRYGB had dyslipidemia resolution vs. 0% from the rSG group (p = 0.035). Dyslipidemia resolution was also more common in pSG vs. rSG (68.6% vs. 0.0%; p = 0.001). No significant differences in surgical complications were found.ConclusionRevisional bariatric surgery is effective and safe treating obesity and related comorbidities after AGB. Primary procedures appear to be associated with better weight loss outcomes. Further prospective studies are needed to better understand the role of revisional bariatric surgery.

Long-Term Outcomes 10 Years after Laparoscopic Sleeve Gastrectomy: a Single Center Retrospective Analysis.

Laparoscopic sleeve gastrectomy (LSG) is the most frequently performed bariatric procedure in the world. The aim of the study was to evaluate outcomes after 10years. Patients who underwent LSG between 2005 and 2010 in a single center were retrospectively assessed, focusing mainly on the percentage of excess weight loss (%EWL) after 10years. Inadequate weight loss was defined as a %EWL < 50% or the need to perform a revisional bariatric surgery. Overall, 149 patients underwent LSG, with a median preoperative body mass index of 42.0 ± 6.5kg/m2. Ten patients (6.7%) underwent previous bariatric procedure. Patients eating behavior was described as volume eaters in 73 (49%), sweet eaters in 11 (7.4%) and both volume and sweet eaters in 65 (43.6%). Six patients died during follow-up and 25 patients were lost to follow-up, leaving 118 (79%) patients who completed full follow-up. Thirty-five patients (23.5%) needed a revisional bariatric surgery. For the 83 remaining patients, the mean %EWL was 35.9% at 10years, only 23 of 83 patients (27.7%) had a %EWL ≥ 50%. Thus 80.5% patients (95/118) experienced inadequate weight loss 10years after LSG. A lower %EWL after 1year was predictive for inadequate weight loss after 10years. Ten years after LSG, the rate of inadequate weight loss was high, reaching 80% of patients. Thirty percent of patients required a revisional bariatric procedure. New studies must try to identify patients who are good candidates for LSG and strategies to improve long-term outcomes.

Characteristics and outcomes for patients undergoing revisional bariatric surgery due to persistent obesity: a retrospective cohort study of 10,589 patients.

Revisional bariatric surgery in an option for patients who experience weight regain or inadequate weight loss after primary elective bariatric procedures. However, there is conflicting data on safety outcomes of revisional procedures. We aim to characterize patient demographics, procedure type, and safety outcomes for those undergoing revisional compared to initial bariatric interventions to guide management of these patients. The 2020 Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) registry was analyzed, comparing primary elective to revisional bariatric procedures for inadequate weight loss. Bivariate analysis was performed to determine between group differences. Multivariable logistic regression determined factors associated with serious complications or mortality. We evaluated 158,424 patients, including 10,589 (6.7%) revisional procedures. Patients undergoing revisional procedures were more like to be female (85.5% revisional vs. 81.0% initial; p < 0.001), had lower body mass index (43.6 ± 7.8kg/m2 revisional vs. 45.2 ± 7.8kg/m2 initial; p < 0.001), and less metabolic comorbidities than patients undergoing primary bariatric surgery. The most common revisional procedures were Roux-en-Y gastric bypass (48.4%) and sleeve gastrectomy (32.5%). Revisional procedures had longer operative duration compared to primary procedures. Patients undergoing revisional procedures were more likely to experience readmission to hospital (4.8% revisional vs. 2.9% initial; p < 0.001) and require reoperation (2.4% revisional vs. 1.0% initial; p < 0.001) within 30days of the procedure. Revisional procedures were independently associated with increased serious complications (OR 1.49, CI 1.36-1.64, p < 0.001) but were not a significant predictor of 30-day mortality (OR 0.74, CI 0.36-1.50, p = 0.409). In comparison to primary bariatric surgery, patients undergoing revisional procedures have less metabolic comorbidities. Revisional procedures have worse perioperative outcomes and are independently associated with serious complications. These data help to contextualize outcomes for patients undergoing revisional bariatric procedures and to inform decision making in these patients.

Revisional bariatric procedures in the group of patients over 60 years of age: a multicenter cohort study (PROSS Study).

The constantly increasing prevalence of obesity in the population and the lengthening of life expectancy affect the appearance of the problem of pathological obesity also in the elderly. At the same time, an increase in the number of bariatric procedures (also revisional) performed in elderly patients is observed. To assess the indications for revisional bariatric procedures along with the safety and postoperative results in the group of patients over 60 years of age. The study was conducted in 2019-2020 among patients undergoing revisional bariatric procedures in Polish bariatric centers. The data were obtained through a multicenter, observational retrospective study. Our data consist of 55 (8.1%) patients older than 60 years of age who underwent revisional bariatric procedures. Revisional procedures in the group of patients over 60 years of age had fewer postoperative complications (16.4% vs. 23.1%, p < 0.05). Remission of type II diabetes or arterial hypertension was achieved to a lesser extent in patients operated on over the age of 60 (13% and 15%, respectively) compared to patients operated on under the age of 60 (47% and 34%, respectively; p < 0.05). Revisional bariatric procedures in the group of patients over 60 years of age do not cause an increased risk of postoperative complications or prolonged hospital stay. The possibility of achieving remission or improvement in the treatment of comorbidities in patients operated on over 60 years of age is relatively lower compared to a younger group.

Analysis of the risk factors for perioperative morbidity after laparoscopic revisional bariatric procedures: results from the multicenter Polish Revision Obesity Surgery Study.

The growing number of primary bariatric operations has led to an increase in demand for revision surgeries. Higher numbers of revisional operations are also observed in Poland, yet their safety and efficacy remain controversial because of a lack of current recommendations and guidelines. To review risk factors influencing perioperative morbidity. A retrospective study was conducted to analyze the results of surgical treatment among 12 Polish bariatric centers. Inclusion criteria were laparoscopic revisional bariatric surgeries and patients ≥18 years of age. The study included 795 patients, of whom 621 were female; the mean age was 47 years (range: 40-55 years). Perioperative morbidity occurred in 92 patients (11.6%) enrolled in the study, including 76 women (82.6%). The median age was 45 years (range: 39-54 years). Statistically significant risk factors in univariate logistic regression models for perioperative complications were the duration of obesity, revisional surgery after Roux-en-Y gastric bypass (RYGB) or adjustable gastric band (AGB), difference in body mass index before revisional surgery and the lowest achieved after primary surgery, and postoperative morbidity of the primary surgery as the cause for revisional bariatric surgery. These factors were included in the multivariate regression model. Revisional surgery after AGB (odds ratio [OR] = 2.18; 95% confidence interval [CI]: 1.28-3.69; P = .004), revisional surgery performed after RYGB (OR = 6.52; 95% CI: 1.98-21.49; P = .002), and revisions due to complication of the primary surgery (OR = 1.89; 95% CI: 1.06-3.34; P = .030) remained independent risk factors for perioperative morbidity. Revisional operations after RYGB or AGB and those performed because of postoperative morbidity after primary surgery as the main cause for revisional surgery were associated with a significantly increased risk of postoperative morbidity.

Bariatric Surgery Conversions in MBSAQIP Centers: Current Indications and Outcomes.

The demand for revisional bariatric surgery has increased, and bariatric conversions (BC) to a different procedure represent most of the revisional cases. The 2020 Metabolic and Bariatric Surgery Accreditfnation and Quality Improvement Program (MBSAQIP) database was expanded to include additional variables on BC. This study aims to analyze the indications and outcomes of BC. A retrospective analysis of the 2020 MBSAQIP database was performed. Patients who underwent BC were included in the analysis. Index procedures, rates, and indications for BC of the different bariatric operations were described. Outcomes of the most frequent BC were analyzed. A total of 168,548 bariatric surgeries were done; 20,387 (12.1%) were revisional, and from those 15,031 (73.7%) were BC. The most converted index operations were sleeve gastrectomy (SG) (49.3%) and adjustable gastric banding (AGB) (45.9%). The most frequent conversions were SG to Roux-en-Y gastric bypass (RYGB) (40.3%) for gastroesophageal reflux disease (GERD) (54.2%) and weight loss failure (WLF) (35.8%), AGB to SG (27%) or RYGB (16.2%) for WLF (67% and 61.3%, respectively), and SG to biliopancreatic diversion with duodenal switch (3.2%) or single anastomosis duodeno-ileal bypass (2%) for WLF (91.2% and 92.4%, respectively). Postoperative overall morbidity, serious morbidity, reoperation, and mortality rates ranged from 5.3 to 20.8%, 2.3 to 19.2%, 1.5 to 10%, and 0 to 0.8%, respectively. BC represents the most frequent revisional bariatric procedure. GERD and WLF are the main causes for BC. Further research is needed to define the ideal BC according to the index procedure and indication.

Safety of Endoscopic Sleeve Gastroplasty with a Single-Channel Endoscope.

Less invasive endoscopic bariatric procedures are under development for the management of class I of obesity. The purpose of our study is to evaluate the safety of endoscopic sleeve gastroplasty (ESG) using the new suturing device OverStitch Sx™. This is a retrospective single-center study over 191 patients using the ESG under general anesthesia with overnight inpatient observation between January 2019 and December 2020. The analyzed variables were adverse effects and change in body weight at 6 and 12months of follow-up. A total of 191 patients underwent ESG for primary obesity. There were 173 female (90.6%) with a mean age of 36.9years. The mean BMI was 33.7kg/m2 (range: 28.9-54). There were no major intra-procedure adverse events. There were two postprocedural complications (1.04%), a transparietal suturing of falciform ligament which needed laparoscopic exploration for severe abdominal pain and a perigastric collection with antibiotic treatment, both with favorable outcome. Considering the weight loss results, the %TWL recorded was 22.4% for 84 patients (43.9%, 6months' follow-up) and 18.7% for 69 patients (36.1%, 12months' follow-up) with the mean EWL of 41.6% and respectively 34.7%. A total of 59 patients (30.9%) were lost follow-up and 12 patients underwent revisional bariatric procedure. According to ASGE definition, 53.8% (n = 71) reached > 25% of EWL. Endoscopic gastroplasty represents a safe minimal invasive approach with the new device OverStitch Sx™ that can be considered an effective and well-tolerated procedure especially for primary obesity treatment.

Controversial Role of Robot in Primary and Revisional Bariatric Surgery Procedures: Review of the Literature and Personal Experience.

Laparoscopy is the surgical standard of care for bariatric procedures; however, during the last two decades, the robotic approach has gained increasing interest. It is currently considered a safe and effective alternative to laparoscopy. This literature review investigates the role of the robotic approach for primary and revisional bariatric procedures, with the particular aim of comparing this technique with the standard-of-care laparoscopic approach. The feasibility of robotic dissection and suturing could have potential advantages: robotics may prevent the risk of leak and bleeding and other surgical complications, determining potential benefits in terms of operative time, length of hospital stay, and learning curve. Considering primary procedures, the literature reveals no advantages in robotic versus the laparoscopic approach for adjustable gastric banding and sleeve gastrectomy. Robotic Roux-en-Y gastric bypass is associated with a longer operative time and a shorter hospital length of stay than laparoscopy. The robotic approach in revisional surgery has been proven to be safe and effective. Despite the longer operative time, the robotic platform could achieve a lower bleeding rate compared with laparoscopy. The surgeon’s selection criteria related to referrals to the robotic approach of difficult-perceived cases could represent a bias. In conclusion, robotic surgery can be considered a safe and effective approach in both primary and revisional bariatric surgery, despite the lack of evidence to support its routine use in primary bariatric surgery. However, in revisional bariatric surgery and in surgical complex procedures, the robotic approach could have potential benefits in terms of surgical complications and learning curves.

Outcome of revisional procedures up to 14 years after sleeve gastrectomy: A single-center experience

Abstract Objective In the long-term, laparoscopic sleeve gastrectomy (SG) may be associated with insufficient weight loss, weight regain, development of gastroesophageal reflux disease (GERD) as well as persistence or relapse of comorbidities. The study's objective was to present results regarding weight loss, evolution of comorbidities and reoperation rate of patients who underwent a revisional bariatric procedure after SG. Methods Retrospective single-center analysis of a prospective database on patients who had a minimal follow-up of two years after conversion from SG to either a proximal Roux-en-Y gastric bypass (PRYGB), biliopancreatic diversion type duodenal switch (BPD/DS), long bilio-pancreatic limb-Roux-en-Y gastric bypass (LRYGB) or re-sleeve gastrectomy (RSG). Results Over a time period of 14 years, 549 SGs were performed. A total of 71 patients (13.0%) underwent a conversion from SG to PRYGB (n = 28, 39.4%), BPD/DS (n = 19, 26.8%), LRYGB (n = 17, 23.9%) and RSG (n = 7, 9.9%). Indications for the revisional procedures were GERD (33.8%), insufficient weight loss/weight regain (32.4%), a combination of both (31.0%) or stenosis/kinking of the sleeve (2.8%). The mean time from SG to revision was 5.2 ± 3.1 years and the mean pre-revisional body mass index (BMI) was 38.0 ± 7.5 kg/m2. The mean follow-up time after revision was 5.1 ± 3.1 years. The overall percentage of total weight loss (%TWL) was greatest after BPD/DS (36.6%) and LRYGB (32.9%) compared to RSG (20.0%; p = 0.04; p = 0.01). Patients with BPD/DS had significantly higher additional %TWL (26.2%) after conversion compared to PRYGB (15.6%, p = 0.04) and RSG (10.9%, p = 0.01). In case of GERD, reoperation led to a resolution of symptoms in 81.6% after RYGB. 19.7% of patients underwent an additional revisional procedure for internal herniation, chronic diarrhea after BDP/DS, common bile duct stones and weight regain. Conclusion In the event of insufficient weight loss/weight regain after SG, conversion to BPD/DS provides a significant post-revisional weight loss. RYGB leads to good symptom control in patients suffering from GERD.

Laparoscopic one anastomosis gastric bypass: A revisional procedure for failed laparoscopic sleeve gastrectomy

AbstractBACKGROUNDThe indications for bariatric surgery revision are weight loss failure, complications or weight regain so laparoscopic one anastomosis gastric bypass (LOAGB) is a promising revisional bariatric procedure for failed laparoscopic sleeve gastrectomy (LSG).AIM OF STUDYThe aim was to evaluate LOAGB as a revisional bariatric procedure for failed LSG regarding weight loss, improvement in comorbidities and complications.PATIENTS AND METHODSThis prospective study was carried out at the Gastrointestinal and Laparoscopic Surgery Unit, General Surgery Department, Tanta University, between Jan 2018 and June 2019. It included 40 patients who underwent LOAGB as a revisional bariatric procedure for failed LSG.RESULTSThe study population included 32 females and 8 males with a mean age of 28.20 ± 7.22 years. The mean preoperative body mass index (BMI) was 45.54 ± 5.24 kg/m2. The mean operative time was 80.59 ± 35.42 min and the mean postoperative hospital stay was 3.35 days. Neither conversion to open or to other bariatric procedures, nor mortality occurred. Revisional surgery was performed 45 ± 10.5 months after primary LSG Concomitant procedures were cholecystectomy in 4 patients (10%) and re‐sleeve for wide proximal pouch occurred in 15 patients (37.5%). Early complications were encountered in 4 patients (10%), intraluminal bleeding was recorded in 1 patient (2.5%). Late complications included 8 patients (20%). The mean postoperative excess body weight loss percent achieved was 45.23 ± 12.35 at 1 year, 58.85 ± 14.60 at 2 years. The mean BMI achieved was 34.52 ± 4.26 at 1 year, 29.37 ± 6.95 at 2 years.CONCLUSIONLaparoscopic one anastomosis gastric bypass is an easy, safe and effective revisional bariatric procedure for failed LSG producing satisfactory weight loss and improvement or resolution of comorbidities with low perioperative complications.

Safety of Primary Versus Revisional Biliopancreatic Diversion with Duodenal Switch in Patients with Super Obesity Using the MBSAQIP database.

For patients with super obesity (BMI > 50kg/m2), biliopancreatic diversion/duodenal switch (BPD/DS) can be an effective bariatric operation. Technical challenges and patient safety concerns, however, have limited its use as a primary procedure. This study sought to assess the safety of primary versus revisional BPD/DS. The MBSAQIP database was queried for primary and revisional BPD/DS (2015-2018). Inclusion criteria were patients ≥ 18years of age, BMI > 50kg/m2, and with no concurrent procedures. Preoperative variables were compared using a chi-square test or Wilcoxon two-sample tests. Multivariate logistic or robust linear regression models were used to compare outcomes. There were 3,378 primary BPD/DS and 487 revisional BPD/DS patients. Primary BPD/DS patients had higher BMI (56.5 [IQR4.4] versus 54.8 [IQR4] kg/m2, p < 0.0001) and had more diabetes mellitus type II (29.1% versus 17.2%, p < 0.0001). Intraoperatively, revisional BPD/DS had longer operative time (165 [IQR47] min versus 139 [IQR100] min, p < 0.0001). After adjusting for preoperative characteristics, there was no difference in 30-day readmission or ED visits (primary 12.9% versus revisional 14.6%), reoperation or reintervention (primary 5.7% versus revisional 7.8%), or mortality (primary 0.4% versus revisional 0.6%). In contrast, the revisional BPD/DS patients had higher odds of major morbidity (primary 3.4% versus revisional 5.3%, OR 1.9, CI 1.1-3.2, p = 0.019). Revisional BPD/DS is associated with higher morbidity than primary BPD/DS in patients with super obesity. These patients should thus be counselled appropriately when choosing a primary or revisional bariatric procedure.

OUTCOME OF MINI GASTRIC BYPASS AFTER FAILED VERTICAL BAND GASTROPLASTY IN TREATMENT OF MORBID OBESE PATIENTS

Background: Bariatric surgery has long been introduced for weight control if conservative treatment failed and was widely accepted in the past decades. Compared with nonsurgical strategies, bariatric surgery proves more effectiveness for moderately to severely obese people to lose weight. Besides, bariatric surgery was demonstrated to induce significant and long-term remission of obesity related comorbidities.Aim of The Work: The aim of this study to review the outcome of Mini gastric bypass as a line of management of failed VBG operation in treatment of morbid obese patients as regard weight loos, intraoperative complications, postoperative complications and other comorbidities within one year follow up after operation.Patients and Methods: Our study includes thirty (30) morbidly obese patients who fulfilled the criteria for bariatric surgery with BMI >40 or >35 with associated co-morbidities with failure of previous restrictive operation (VBG). These patients were enrolled in a prospective study and had a retrospectively gathered outcome analysis at the department of surgery Ain-Shams University Hospitals. Our study was conducted in El-Demerdash hospital, Ain- Shams University. Thirty patients were selected and operated upon from June 2017 till June 2019 and followed up to June 2020.Results: In our study causes of revision in (30) patients: weight regain (10) patients severe GERD (9) patients, un satisfactory weight loss (8) patients, eating difficulties (3) patients. In our study The mean initial BMI for the patients was The preoperative BMI with mean ± SD: 42.9 ± 7.21 kg/m2, was higher than post-operative BMI at 3 months with mean ± SD value of 38.03± 5.62 kg/m2), than post-operative BMI at 6 months with mean ± SD value of 33.98 ± 4.58 kg/m2, than post-operative BMI at 12 months with mean ± SD value of 29.22 ± 3.60 kg/m2.Conclusion: Mini-gastric bypass offers major benefits with quite satisfactory results over most alternative procedures. Our data, which includes follow up of two years, indicates that mini gastric bypass is: An effective procedure for the treatment of failed restrictive procedure (VBG). Technically feasible. Safe operation with a low rate of major postoperative complications. Has a significant reduction in patient’s hospital stay. Helps in the achievement of a significant weight loss and improvement of obesity related metabolic co morbidities. Efficient in loosing excess weight and in maintaining the weight loss. so it is considered a promising revisional bariatric procedure operation for patients with failed prior open or laparoscopic VBG

Efficacy and Drawbacks of Single-Anastomosis Duodeno-Ileal Bypass After Sleeve Gastrectomy in a Tertiary Referral Bariatric Center

BackgroundThe need for revisional procedures after sleeve gastrectomy (SG) for insufficient weight loss or weight regain, gastroesophageal reflux, or other complications is reported to be 18–36% in studies with 10-year follow-up. Single-anastomosis duodeno-ileal bypass (SADI) may be performed as a revisional procedure after SG. This study aims to evaluate the short- and mid-term outcomes of SADI after SG in a referral center for bariatric surgery.Materials and MethodsData of patients who underwent SADI between March 2015 and March 2020 were collected prospectively and analyzed retrospectively. Follow-up comprised clinical and biochemical assessment at 1, 3, 6, 12, 18, and 24 months postoperatively, and once a year thereafter.ResultsOverall, 106 patients underwent SADI after a previous SG. The timeframe between SG and SADI was 50 ± 31.3 months. Postoperative mortality was observed in two cases (1.8%) and morbidity in 15.1% of patients. At 24 months, %total weight loss was 37.6 ± 12.3 and %excess weight loss 76.9 ± 25.2 (64 patients). Three patients were treated for malnutrition during follow-up, two with medical treatment and one with SADI reversal.ConclusionSADI after SG provides effective weight loss results in the short-term, even if in the present series the postoperative complication rate was non-negligible. Further trials are needed to establish the more advantageous revisional bariatric procedure after failed SG.

Laparoscopic Sleeve Gastrectomy Following Failed Laparoscopic Adjustable Gastric Banding-a Comparison Between One- and two-Stage Procedures, an Israeli National Database Study.

The optimal revisional bariatric surgery procedure following a previous failed gastric band surgery is yet to be determined. The aim of our study was to compare single- and two-stage laparoscopic sleeve gastrectomy (LSG) following laparoscopic adjustable gastric banding (LAGB) in terms of short- and mid-term outcomes. Patients who underwent LSG after a failed LAGB in Israel during 2014-2017 were included. Data were obtained from the Israeli National Bariatric Surgery Registry. Data analyzed included comorbidities, postoperative complications, and anthropometric outcomes. Of 595 patients included in the data analysis, 381 (64%) underwent one-stage and 214 (36%) had two-stage LSG. No differences were observed between the groups in complication rates (5.0 vs. 5.1%, p=0.93). Percent of total weight loss was lower following one-stage than two-stage procedure at both 6 months (19.3±9.3 vs. 21.5±8.1%; p=0.02) and 1 year postoperative (24.9±10.4 vs. 27.8±9.9%; p=0.02). No difference was observed in the percent excess weight loss (51 vs. 56%; p=0.34 and 66 vs. 72%; p=0.38, at 6 months and 12 months postoperative, respectively). In a regression analysis, percent excess weight loss was greater in the two-stage procedure (p=0.02), with no difference in the complication rates (p=0.98). Single-step LSG had a similar safety profile as two-stage LSG following a failed LAGB. Better weight loss was seen following two-stage LSG. Further prospective studies should investigate long-term follow-up after one- and two-stage procedure.

Role of Robotic Surgery in Complex Revisional Bariatric Procedures.

Revisional bariatric surgery (RBS) is becoming more common, with an estimated increase of more than 300% from 2017 to 2018. For these complex procedures, the role of robotics is still debated. The purpose of our study is to report the safety and effectiveness of robotic-assisted RBSs. A retrospective review of electronic medical records was conducted for robotic-assisted RBSs performed at the Mayo Clinic in Florida, between January 1, 2016, and January 1, 2020. Peri- and postoperative data were analyzed, reviewing patient characteristics, indications for surgery, and outcomes. From 160 RBSs performed during the study period, 67 were robotic-assisted and met inclusion criteria. Primary procedures included sleeve gastrectomy (26 [38.8%]), adjustable gastric band (24 [35.8%]), Roux-en-Y gastric bypass (14 [20.9%]), vertical-banded gastroplasty (2 [3.0%]), and duodenal switch (1 [1.5%]). RBSs performed were Roux-en-Y gastric bypass (49 [73.1%]), redo gastrojejunostomy (14 [20.9%]), and duodenal switch (4 [6.0%]). Rate of conversion to open procedure and rate of readmission 1month after surgery were 6.0% and 7.5%, respectively. Rate of 30-day Clavien-Dindo grade III or higher adverse events was 4.5%. No anastomotic leaks were documented. Fifty-two patients presented with preoperative symptoms, and 69.2% reported improvement after RBS. Mean (SD) excess weight loss was 57.62% (23.80) 12months after RBS. Robotic-assisted RBSs are safe with low major adverse event rates. Symptom resolution and weight loss outcomes are acceptable.

Revisional bariatric surgery to single-anastomosis gastric bypass: a large multi-institutional series

Abstract Background Reoperation is often required after bariatric procedures. Single-anastomosis gastric bypass (SAGB) is increasingly utilized as a primary bariatric procedure. Few series document SAGB as a revisional bariatric procedure. Objectives To describe our short-term experience with revisional SAGB, focusing on weight loss and reflux symptom outcomes. Setting Three hospitals in Australia with both private and public (government funded) patients. Methods We reviewed all revisional SAGB cases from 2012 to 2019 at. Complications were considered significant if they were Clavien-Dindo grade 3a or higher. A phone survey was conducted to assess weight loss outcomes, patient satisfaction, reflux symptoms, and other complications. Results We identified 254 patients who had a revisional bariatric procedure to SAGB (21 previous sleeve gastrectomies and 233 previous adjustable bands), with a mean follow-up of 22 ± 15.6 months (range, 1–55 mo). The mean percentage of excess weight loss was 77% (183 patients, 72%), and the number of patients with follow-ups at 1 and 4 years was 184 (73%) and 35 patients (14%). Within 30 days, there were 29 patients (11%) who required reinterventions (21 endoscopies, 1 interventional radiology procedure, and 7 reoperations) with no deaths. Beyond 30 days, 27 patients (11%) required rerevision to Roux-en-Y gastric bypass for reflux symptoms and 10 (4%) required a laparotomy or laparoscopy for another reason (e.g., bowel obstruction). At a median follow-up of 36.6 months, 87 patients (34%) completed a phone survey, 45 (52%) of whom were taking proton pump inhibitors and 66 patients (76%) of whom were satisfied with their experience. Conclusion In our series, revision to SAGB was safe, with low short-term morbidity and favorable weight loss outcomes. However, beyond 1 year, a large proportion of patients experienced severe reflux symptoms and required rerevision.