Bariatric Surgery Conversions at a Revisional Referral Center: A Subset Analysis of Clinical Outcomes from a Rural Community Hospital Accredited Program

Introduction: Revisional bariatric surgery for complications and weight regain is associated with higher morbidity and mortality rates compared to primary bariatric surgery. The majority of procedures are done in an urban setting. Methods: A retrospective chart review with IRB approval was conducted in a rural community hospital accredited bariatric program. A total of 53 revisions were performed by a single surgeon from February 2019 to February 2020. A subset analysis of 18 bariatric surgery conversions was performed and its outcomes are presented. Primary outcomes were 30-day morbidity and mortality. Secondary outcomes included anastomotic or staple line leak, intraabdominal abscess and need for subsequent surgery. Results: Most patients were female (83.3%) and the median ASA class was 3. The mean age was 48.2 ± 13.3 years. Most conversions were performed laparoscopically (88.9%), with a minority done robotically (11.1%). There were no open procedures or conversions to open. The most common prior bariatric operation was a sleeve gastrectomy (SG) (44.4%) followed by vertical banded gastroplasty (VBG) (22.2%). The most common type of operation was laparoscopic SG conversion to Roux-en-Y gastric bypass (RYGB) (16.7%) followed by laparoscopic VBG conversion to RYGB (16.7%). History of tobacco use was present in 38.9% of patients. The most common preoperative comorbidity was severe gastroesophageal reflux disease (GERD) (88.9%). The 30-day morbidity was 33.3% and there was no mortality. There were no anastomotic or staple line leaks. Intraabdominal abscess developed in 11.1% of patients. The rate of marginal ulceration was 27.8%, with only one case (5.6%) requiring future gastrojejunostomy revision. The rate of subsequent surgery beyond 30 days was 22.2%. Conclusion: With an acceptable complication rate, no anastomotic or staple line leaks, and no mortality, minimally invasive bariatric surgery conversions are feasible and safe in a rural community hospital environment, with the most common indication being complications from a prior laparoscopic SG, and with the RYGB being the most common procedure as an end product of conversion.