Revisional bariatric surgery is risky but potentially beneficial for most patients, according to a recent study published in the February issue of JAMA’s Archives of Surgery. Researchers found that although complications are likely to occur, most patients ended up with overall positive outcomes after revisional bariatric surgery.
The purpose of the study was to evaluate the safety and effectiveness of revisional bariatric surgery. Revisional bariatric operations, which are increasing in number, are performed when patients have unsuccessful weight loss or intolerable complications following the initial bariatric intervention.
Based on study findings, the researchers concluded that although revisional bariatric surgery is associated with a higher risk of complications than the original procedures, it appears to be safe and effective when performed in experienced centers.
The study was conducted by Charalambos Spyropoulas, M.D., and colleagues from the University Hospital of Patras, Rion, Greece. They studied 56 patients who underwent revisional bariatric surgery between 1995 and 2008 and had originally undergone either gastric bypass surgery or the biliopancreatic diversion procedure. Revisions were performed due to unsatisfactory weight loss (39 patients), severe nutritional complications (15 patients), and intolerable adverse effects from the initial procedure including blocking or narrowing of the digestive tract (2 patients).
Patients were followed for an average of 102 months after the revisional surgery. The following complications and positive outcomes were reported:
- Early complications (within 30 to 90 days of surgery) occurred at a rate of almost 34% (19 patients), which included acute renal failure, anastomotic leaks, pneumonia, wound infection, opening of the surgical wound, bile leak, and small-bowel obstruction.
- Late complications (more than 90 days after surgery) was slightly more than 23%, which included narrowing of the passageway between the stomach and intestine, low levels of albumin indicating protein malnutrition, and development of a hernia at the incision site.
- Patients who had inadequate weight loss experienced a significant drop in BMI, from an average of 55.4 to an average of 35. The average loss of excess body weight was 68.9 percent.
- Patients with nutritional complications say all clinical signs and symptoms of protein malnutrition were completely resolved.
- The two patients with intolerable complications after original procedure reported positive outcomes.
The options for revisional bariatric surgery can vary based on the original procedure. New non-surgical techniques such as StomaphyX and ROSE are making revisions safer for gastric bypass patients. As the number of bariatric surgery procedures continue to increase, the need for safe and effective revisions will continue to be necessary for the health and safety of patients.
