Revisional Bariatric Surgery in Israel: Findings from the Israeli Bariatric Surgery Registry

Bariatric surgery (BS) is a proven sustainable approach for obesity, and its frequency is increasing worldwide. However, the frequency of revision surgery (RS) is also increasing. This study aimed to evaluate the RS rate in Israel and compare RS to primary surgery (PS).

Data were obtained from the Israeli Bariatric Surgery Registry. All patients aged > 18 years who underwent BS between June 2013 and December 2016 were considered for inclusion. Sociodemographic and clinical data were analyzed.

PS was performed in 28,707 patients and RS was performed in 4026 patients. The mean body mass index values were 42.1 ± 5.0 and 41.3 ± 7.0 kg/m² in the PS and RS groups, respectively. Hypertension, type 2 diabetes mellitus, dyslipidemia, and fatty liver were less frequent in the RS group than in the PS group. The percentage total weight loss (%TWL) values 6 months and 1 year postoperatively were 25.1 ± 8.1% and 30.5 ± 9.5%, respectively, in the PS group and 18.5 ± 8.9% and 23.12 ± 11.4%, respectively, in the RS group (P < 0.001). Complications were noted in 856 (3.5%) and 210 (6.2%) patients from the PS and RS groups, respectively. A multilinear regression model found that more weight loss was significantly associated with RS type (revision bypass vs. revision restrictive surgery).

The RS rate is continuously increasing, and it should be tapered according to indications and feasibility. Our findings indicate that RS can be performed with acceptable complication rates and that restrictive surgery should be converted to bypass surgery to achieve acceptable weight loss with fewer complications.