Outcomes of a third bariatric procedure for inadequate weight loss

The robust volume of bariatric surgical procedures has led to significant numbers of patients requiring reoperative surgery because of undesirable results from primary operations. The aim of this study was to assess the feasibility, safety, and outcomes of the third bariatric procedure after previous attempts resulted in inadequate results.

We retrospectively identified patients who underwent a third bariatric procedure for inadequate weight loss or significant weight regain after the second operation. Data were analyzed to establish patient demographic characteristics, perioperative parameters, and postoperative outcomes.

A total of 12 patients were identified. Before the first, second, and third procedures, patients had a mean body mass index of 67.1±29.3 kg/m2, 60.9±28.3 kg/m2, and 49.4±19.8 kg/m2, respectively. The third operations (laparoscopic in 10 and open in 2) included Roux-en-Y gastric bypass (n=5), revision of pouch and/or stoma of Roux-en-Y gastric bypass (n=3), limb lengthening after Roux-en-Y gastric bypass (n=3), and sleeve gastrectomy (n=1). We encountered 5 early complications in 4 patients, and early reoperative intervention was needed in 2 patients. At 1-year follow-up, the excess weight loss of the cohort was 49.4%±33.8%. After a mean follow-up time of 43.0±28.6 months, the body mass index of the cohort reached 39.9±20.8 kg/m2, which corresponded to a mean excess weight loss of 54.4%±44.0% from the third operation. At the latest follow-up, 64% of patients had excess weight loss>50% and 45% had excess weight loss>80%.

Reoperative bariatric surgery can be carried out successfully (often laparoscopically), even after 2 previous weight loss procedures.