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Laparoscopic Revision of Failed Bariatric Procedures
Constantine T Frantzides1, Brad Alexander2, Alexander T Frantzides1
1Chicago Institute of Minimally Invasive Surgery, Skokie, Illinois, USA.
JSLS : Journal of the Society of Laparoendoscopic Surgeons
|January 25, 2019
Summary
Revisional laparoscopic bariatric surgery effectively addresses weight regain and complications. Procedures incorporating malabsorption yield greater weight loss compared to restriction alone, with low mortality rates.
Area of Science:
- Bariatric Surgery
- Laparoscopic Surgery
- Obesity Treatment
Background:
- Revision of bariatric surgery is indicated for inadequate weight loss, weight regain, or complications.
- Revisional goals include restoring restriction and/or adding malabsorption.
- Laparoscopic techniques are employed for these complex procedures.
Purpose of the Study:
- To evaluate the effectiveness of revisional laparoscopic bariatric surgery for weight loss.
- To assess the risks and benefits of these technically demanding procedures.
Main Methods:
- Retrospective analysis of 271 revisional laparoscopic bariatric surgery cases (2001-2013).
- Patients grouped by primary procedure and revision type.
- Weight loss, operative time, hospitalization, morbidity, and mortality were analyzed.
Main Results:
- Four groups analyzed: adjustable gastric band to gastric bypass (GBP) conversion (35.3% weight loss), dilated GBP pouch reduction (22.9%), GBP pouch reduction/limb elongation (39.4%), and vertical banded gastroplasty to GBP conversion (33.2%).
- Average operative times ranged from 75 to 205 minutes; average hospitalization from 1.0 to 2.5 days.
- Complication rates were low (0-5.2%), with no mortalities.
Conclusions:
- Revisional bariatric surgery outcomes vary based on the original procedure and reason for revision.
- Malabsorptive revisional procedures lead to greater weight loss than restrictive ones.
- Identifying and correcting surgically correctable deficiencies is crucial for inadequate weight loss cases.
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