Causes of revisional surgery, reoperations, and readmissions after bariatric surgery

Abstract Background 20–30% of patients show a lack of response after bariatric surgery (BS). These non-responders may experience insufficient weight loss or significant weight regain. Based on previous research in our center, it has been identified that before the introduction of a multidisciplinary team (MDT), 68% of the non-responders underwent revisional surgery. This study describes the effect of an MDT on treatment strategy in non-responders after BS. Methods this retrospective study included non-responders that were reviewed in an MDT meeting. Patients were categorized as primary non- responders (1NR) or as secondary non-responders (2NR). Outcomes assessed were: I. MDT-based treatment (conservative versus operative), II. Weight loss, III. Complications after revisional surgery. Results a total of 104 patients were included (n = 15 1NR, n = 89 2NR). In 73 patients, lifestyle and/or behavioral changes were indicated. Only eleven patients (13%) were re-operated in which one complication occurred. Twenty patients did not show up at their appointment with the dietician, physical therapist and/or medical psychologist and were excluded from further analysis. Conservatively treated patients lost 2.1 kg < 12 months (SD = 7.29) and 0.8 kg < 24 months (SD = 5.08). Surgically treated patients lost 12.0 kg < 12 months (SD = 4.29) and 26.3 kg < 24 months (SD = 2.75). Conclusions the rate of revisional surgery decreased after the introduction of an MDT. An explanation for this could be that an MDT drives more patients towards a conservative treatment since it identifies modifiable lifestyle and/or behavioral factors contributing to non-response. Incorporation of an MDT may contribute to the selection of patients who might benefit from revisional surgery.

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Weight Loss Failure after Sleeve Gastrectomy and its Management

QJM ◽

10.1093/qjmed/hcab097.028 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Alaa Abbas Sabry Moustafiz ◽

Mohamed Abd Elmoniem Marzouk ◽

Basem Helmy El Shayeb ◽

Karim Al Amir Mohamed Tawfik

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Revisional Surgery ◽

University Hospital ◽

Controlled Study ◽

Excess Body Weight ◽

Morbidly Obese ◽

Weight Loss Failure

Abstract Background Obesity has become an increasingly important global health problem. Laparoscopic sleeve gastrectomy is the most widely performed bariatric surgery. Aim of the Work To evaluate patients who failed to lose weight or regained weight after perfonning sleeve gastrectomy and how to manage them. Patients and Methods This study has been conducted at Ain Shams university hospital (Al Demerdash hospital) Ain Shams University. This is a prospective randomized controlled study (RCT) where 30 patients (20 females and 10 males) attended the outpatient clinic of the bariatric surgery unit complaining of failure of sleeve gastrectomy defined as: (failure to lose 500 0 of excess body weight or regain up to 200 0 of lost excess weight within one year or more from sleeve gastrectomy). Results All three operations have promising outcomes regarding weight loss and comorbidities resolution like diabetes mellitus and hypertension in morbidly obese patients. When compared to RE-LSG, SADI and OAGB have better results regarding weight loss. Conclusion Weight loss failure and revisional surgery remain primary long term concern after laparoscopic sleeve gastrectomy. There are currently no guidelines or systemic reviews directing the standered of practice tör revisional surgery in patients with failed primary sleeve gastrectomy.

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Weight Regain Following Bariatric Surgery and Revisional Surgery

Complications in Bariatric Surgery ◽

10.1007/978-3-319-75841-1_12 ◽

2018 ◽

pp. 147-165

Author(s):

Cynthia Weber ◽

Bipan Chand

Keyword(s):

Bariatric Surgery ◽

Weight Regain ◽

Revisional Surgery

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The Anatomy of a Weight Recidivism and Revision Bariatric Surgical Clinic

Gastroenterology Research and Practice ◽

10.1155/2014/721095 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

C. J. de Gara ◽

S. Karmali

Keyword(s):

Bariatric Surgery ◽

Revisional Surgery ◽

Vertical Band Gastroplasty ◽

Laparoscopic Adjustable Gastric Band ◽

Revisional Bariatric Surgery ◽

Clinical Psychologist ◽

Clinical Activity ◽

Weight Recidivism ◽

Primary Surgery ◽

Early Results

Abstract. Weight recidivism in bariatric surgery failure is multifactorial. It ranges from inappropriate patient selection for primary surgery to technical/anatomic issues related to the original surgery. Most bariatric surgeons and centers focus on primary bariatric surgery while weight recidivism and its complications are very much secondary concerns.Methods. We report on our initial experience having established a dedicated weight recidivism and revisional bariatric surgery clinic. A single surgeon, dedicated nursing, dieticians, and psychologist developed care maps, goals of care, nonsurgical candidate rules, and discharge planning strategies.Results. A single year audit (2012) of clinical activity revealed 137 patients, with a mean age 49 ± 10.1 years (6 years older on average than in our primary clinic), 75% of whom were women with BMI 47 ± 11.5. Over three quarters had undergone a vertical band gastroplasty while 15% had had a laparoscopic adjustable gastric band. Only 27% of those attending clinic required further surgery. As for primary surgery, the role of the obesity expert clinical psychologist was a key component to achieving successful revision outcomes.Conclusion. With an exponential rise in obesity and a concomitant major increase in bariatric surgery, an inevitable increase in revisional surgery is becoming a reality. Anticipating this increase in activity, Alberta Health Services, Alberta, Canada, has established a unique and dedicated clinic whose early results are promising.

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Title: Initial results of reoperative bariatric surgery: a retrospective feasibility and safety study at a low-volume unit

10.21203/rs.3.rs-421247/v1 ◽

2021 ◽

Author(s):

Sheng Mao Wu ◽

Hung Chieh Lo

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Revisional Surgery ◽

Marginal Ulcer ◽

Revisional Bariatric Surgery ◽

Conversion To Open Surgery ◽

Reoperative Bariatric Surgery ◽

Low Volume ◽

Volume Unit ◽

Robust Evidence

Abstract Background This study assessed the feasibility and results of revisional bariatric surgery at a low-volume unit.Methods This retrospective study was conducted from January 2017 to August 2020; the revision group comprised patients treated for weight regain (WR, n = 6), insufficient weight loss (IWL, n =3), and various complications (n=6). Clinical characteristics and 30-day outcomes were assessed and compared with those of primary bariatric procedures (control, n=173). Results A total of 8.0% (15/188) of patients underwent revisional procedures and tended to be elderly (40.1 vs. 38.2 years), be female (73.3% vs. 54.9%), and have a significantly lower body mass index (33.1 vs. 39.9 kg/m2) and fewer comorbidities than controls. Gastric bypass was the most prevalent revisional procedure. A significantly longer operative duration (155 and 96 min; p < 0.001), longer length of stay (3.7 and 2.4 days) and higher 30-day complication rate (20.0% vs. 4.6%) were found in the revision group, including one case of leakage and another of jejunojejunostomy obstruction. There were no cases of conversion to open surgery or mortality. A total of 5/6 WR patients achieved excessive weight loss >50%, versus only one IWL patient who reached this goal. Complications, including marginal ulcer, fistula and post-sleeve gastrectomy stenosis, were alleviated after revision.Conclusion Revisional surgery appears to be feasible and effective in a low-volume practice in patients with WR and complications after primary bariatric procedures; however, the benefits should be weighed against the risks. More robust evidence is required to support ongoing practice.

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Revisional surgery in severe nutritional complications after bariatric surgical procedures: report of four cases from a single institution and review of the literature

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-6991e-20202666 ◽

2021 ◽

Vol 48 ◽

Author(s):

JOÃO GABRIEL ROMERO BRAGA ◽

MATHEUS MATHEDI CONCON ◽

AMANDA PEREIRA LIMA ◽

GUILHERME HOVERTER CALLEJAS ◽

ARY DE CASTRO MACEDO ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Biliopancreatic Diversion ◽

Revisional Surgery ◽

Case Reports ◽

Case Series ◽

Morbidly Obese ◽

Review Of The Literature ◽

Primary Surgery ◽

Nutritional Complications

ABSTRACT Introduction: bariatric surgery is currently the only treatment that leads to long-term and sustained weight loss and decreased morbidity and mortality in morbidly obese individuals. Roux-en-Y bypass causes weight loss by restricting food intake associated with reduced intestinal absorption, in addition to multiple endocrine and satiogenic effects. Biliopancreatic diversion promotes weight loss mainly due to poor absorption of the nutrients ingested. Both procedures exclude parts of the gastrointestinal tract. Objective: to describe four cases of revisional surgery after primary bariatric surgery, due to serious nutritional complications, and to review the literature regarding this subject. Methods: a retrospective analysis of patients of Unicamps bariatric center database and review of the literatures were performed. Results: four patients were identified, 2 women and 2 men, with a mean age of 48 years. The mean body mass index before revisional surgery was 23.7 kg/m2. Three patients underwent Scopinaro biliopancreatic diversion, and onde patient underwent Roux-en-Y gastric bypass. The revisional surgeries were revision, conversion, and reversion. One patient died. For the review of the literature 12 articles remained (11 case reports and 1 case series). Another five important original articles were included. Conclusion: fortunately, revision surgery is rarely necessary, but when indicated it has increased morbidity, It can be revision, reverion or conversion according to the severity of the patient and the primary surgery performed.

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Endoscopic vacuum therapy in salvage and standalone treatment of gastric leaks after bariatric surgery

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02365-9 ◽

2021 ◽

Author(s):

Ahrens Markus ◽

Beckmann Jan Henrik ◽

Reichert Benedikt ◽

Hendricks Alexander ◽

Becker Thomas ◽

...

Keyword(s):

Bariatric Surgery ◽

Revision Surgery ◽

Healing Rate ◽

Revisional Surgery ◽

Leakage Rate ◽

Gastric Leak ◽

Vacuum Therapy ◽

External Drainage ◽

Endoscopic Vacuum Therapy ◽

Inflammatory Changes

Abstract Introduction Gastric leaks constitute some of the most severe complications after obesity surgery. Resulting peritonitis can lead to inflammatory changes of the stomach wall and might necessitate drainage. The inflammatory changes make gastric leak treatment difficult. A common endoscopic approach of using stents causes the problem of inadequate leak sealing and the need for an external drainage. Based on promising results using endoscopic vacuum therapy (EVT) for esophageal leaks, we implemented this concept for gastric leak treatment after bariatric surgery (Ahrens et al., Endoscopy 42(9):693–698, 2010; Schniewind et al., Surg Endosc 27(10):3883–3890, 2013). Methods We retrospectively analyzed data of 31 gastric leaks after bariatric surgery. For leak therapy management, we used revisional laparoscopy with suturing and drainage. EVT was added for persistent leaks in sixteen cases and was used in four cases as standalone therapy. Results Twenty-one gastric leaks occurred in 521 sleeve gastrectomies (leakage rate 4.0%), 9 in 441 Roux-en-Y gastric bypasses (leakage rate 2.3%), and 1 in 12 mini-bypasses. Eleven of these gastric leaks were detected within 2 days after bariatric surgery and successfully treated by revision surgery. Sixteen gastric leaks, re-operated later than 2 days, remained after revision surgery, and EVT was added. Without revision surgery, we performed EVT as standalone therapy in 4 patients with late gastric leaks. The EVT healing rate was 90% (18 of 20). In 2 patients with a late gastric leak in sleeve gastrectomy, neither revisional surgery, EVT, nor stent therapy was successful. EVT patients showed no complications related to EVT during follow-up. Conclusion EVT is highly beneficial in cases of gastric leaks in obesity surgery where local peritonitis is present. Revisional surgery was unsuccessful later than 2 days after primary surgery (16 of 16 cases). EVT shows a similar healing rate to stent therapy (80–100%) but a shorter duration of treatment. The advantages of EVT are endoscopic access, internal drainage, rapid granulation, and direct therapy control. In compartmentalized gastric leaks, EVT was successful as a standalone therapy without external drainage.

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A multidisciplinary approach for non-responders after bariatric surgery: why does it matter?

10.21203/rs.3.rs-48047/v2 ◽

2020 ◽

Author(s):

Marleen Romeijn ◽

Martine Uittenbogaart ◽

François M. H. van Dielen ◽

Arijan A. P. M. Luijten ◽

Loes Janssen ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Conservative Treatment ◽

Multidisciplinary Team ◽

Weight Regain ◽

Multidisciplinary Approach ◽

Physical Therapist ◽

Revisional Surgery ◽

Multidisciplinary Team Meeting ◽

Behavioural Factors

Abstract Background: 20-30% of patients show a lack of response after bariatric surgery. These non-responders may experience insufficient weight loss or significant weight regain. While ongoing studies about the beneficial effect of revisional surgery on non-response are being reported, studies about the contributiveness of a multidisciplinary approach fall behind. The aim of this study was to describe the effect of a multidisciplinary approach on treatment strategy in non-responders after gastric bypass and sleeve gastrectomy.Methods: this retrospective study included non-responders that were reviewed in a multidisciplinary team meeting. Outcomes assessed were: given treatment (conservative versus operative), weight loss and complications after operative treatment. Outcomes were described separately for primary non- responders and secondary non-responders.Results: a total of 104 patients were included (n=15 primary, n=89 secondary non-response). Eleven patients underwent revisional surgery (13%), while 73 patients received conservative treatment as they were not eligible for surgery due to lifestyle and/or behavioural factors. Twenty patients did not show up at their appointment with the dietician, physical therapist and/or medical psychologist and were excluded from further analysis. Conservatively treated patients lost 2.1kg <12 months (SD=7.29) and 0.8kg <24 months (SD=5.08). Surgically treated patients lost 12.0kg <12 months (SD=4.29) and 26.3kg <24 months (SD=2.75). One complication occurred in a patient that underwent revisional surgery.Conclusions: a conservative treatment was more frequently proposed by the multidisciplinary team than a surgical treatment. A multidisciplinary approach can be beneficial for the identification of lifestyle and/or behavioural factors contributing to the development of non-response. More studies would help to establish the position of a multidisciplinary approach in the treatment of non-responders in future practices.

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