Re-operations after Secondary Bariatric Surgery: a Systematic Review

Area of Science:

• Bariatric Surgery
• Surgical Outcomes
• Gastroenterology

Background:

• Secondary bariatric procedures are increasingly common.
• Understanding reoperation rates for complications is crucial for patient management.
• Long-term outcomes and tertiary surgery needs require further investigation.

Purpose of the Study:

• To review reoperation rates for short- and long-term complications following secondary bariatric procedures.
• To assess the need for further (tertiary) bariatric surgery.
• To inform clinical decision-making and economic evaluations.

Main Methods:

• Systematic review of 28 papers including 1317 secondary bariatric cases.
• Follow-up of at least 75% of patients for 12 months or more.
• Analysis of reoperation rates for adjustable gastric banding (AGB) rebanding versus conversions.

Main Results:

• Conversion of AGB to Roux-en-Y gastric bypass showed the highest complication rates (10.7% short-term, 22.0% long-term).
• An estimated 194 additional reoperations per 1000 patients undergoing secondary procedures were identified.
• Approximately 8.8% of patients required tertiary bariatric surgery.

Conclusions:

• Risks associated with long-term complications and tertiary bariatric surgery following secondary procedures are higher than often reported.
• These risks, though poorly documented, must be considered when selecting secondary bariatric interventions.
• Economic evaluations of secondary bariatric procedures should incorporate these higher reoperation risks.