Redo Gastric Restriction: A Higher Risk Procedure

Twenty-one patients have undergone redo gastric restrictive procedures, three after gastric bypass, 18 after gastroplasty. Weight at the time of the redo procedure was 101 kg +/- 32.4 SD (222 lb +/- 71.2) (178% IBW +/- 33.8), down from 137 kg +/- 65.5) (217% ISW +/- 33.9) at the time of initial procedure. Sixteen of 21 (76%) initial procedures failed because of staple-line dehiscence, at least in part. Redo procedures were vertical banded gastroplasty (VBG) in ten, gastric bypass (GB) in ten, and silico ring banded gastroplasty in one. Early complications were three gastric leaks, one enterocutaneous fistula, one gastroplasty outlet obstruction, and one wound infection occurring in three of ten VBG and three of ten GB. All three leaks and one fistula were not seen on gastrograffin/barium swallow done 2-4 days after the redo procedure. Late complications were failure of seven redo procedures, one small bowel obstruction, and one recurrent enterocutaneous fistula, with two lost to follow-up. We conclude that redo gastric restriction procedures carry relatively high perioperative risks. Radiologic contrast studies done in the early postoperative period do not necessarily detect leaks, which are presumably due to gastric ischemia and subsequent infarction. Ischemia is thought to be due to devascularization from the initial procedure. Late failure is unfortunately common, possibly reflecting behaviors which lead to the initial staple line dehiscence and failure. Higher risk of perioperative complications and late failure must be considered prior to revisional surgery.