FROM COMPLEX EVOLVING TO SIMPLE: CURRENT REVISIONAL AND ENDOSCOPIC PROCEDURES FOLLOWING BARIATRIC SURGERY

Area of Science:

• Bariatric Surgery
• Gastroenterology
• Minimally Invasive Surgery

Background:

• Roux-en-Y gastric bypass (RYGB) is a standard bariatric procedure.
• Sleeve gastrectomy and gastric banding may have higher failure rates.
• Complications like band erosion and GERD can necessitate revisional surgery.

Purpose of the Study:

• To analyze institutional and literature data on revisional bariatric procedures.
• To evaluate the best alternatives for managing bariatric surgery failures and complications.
• To assess the efficacy of laparoscopic conversion to RYGB and endoscopic interventions.

Main Methods:

• Institutional experience review.
• Systematic literature review on revisional bariatric surgery.
• Analysis of endoscopic procedures for bariatric complications.

Main Results:

• Endoscopic procedures are emerging for bariatric failure and complications.
• RYGB failure occurs in up to 20%, with transoral outlet reduction as an option.
• Laparoscopic approaches with remnant gastric resection can treat severe hypoglycemia post-RYGB.

Conclusions:

• Revisional and endoscopic procedures are viable for symptomatic patients or treatment failure.
• Non-surgical approaches should be exhausted before considering revisional surgery.
• Complex surgical revisions are increasingly being replaced by simpler endoscopic solutions.