Revisional Surgery After One Anastomosis/Minigastric Bypass: an Italian Multi-institutional Survey

Background Efficacy and safety of OAGB/MGB (one anastomosis/mini gastric bypass) have been well documented both as primary and as revisional procedures. However, even after OAGB/MGB, revisional surgery is unavoidable in patients with surgical complications or insufficient weight loss. Methods A questionnaire asking for the total number and demographics of primary and revisional OAGB/MGBs performed between January 2006 and July 2020 was e-mailed to all S.I.C. OB centres of excellence (annual caseload > 100; 5-year follow-up > 50%). Each bariatric centre was asked to provide gender, age, preoperative body mass index (BMI) and obesity-related comorbidities, previous history of abdominal or bariatric surgery, indication for surgical revision of OAGB/MGB, type of revisional procedure, pre- and post-revisional BMI, peri- and post-operative complications, last follow-up (FU). Results Twenty-three bariatric centres (54.8%) responded to our survey reporting a total number of 8676 primary OAGB/MGBS and a follow-up of 62.42 ± 52.22 months. A total of 181 (2.08%) patients underwent revisional surgery: 82 (0.94%) were suffering from intractable DGER (duodeno-gastric-esophageal reflux), 42 (0.48%) were reoperated for weight regain, 16 (0.18%) had excessive weight loss and malnutrition, 12 (0.13%) had a marginal ulcer perforation, 10 (0.11%) had a gastro-gastric fistula, 20 (0.23%) had other causes of revision. Roux-en-Y gastric bypass (RYGB) was the most performed revisional procedure (109; 54%), followed by bilio-pancreatic limb elongation (19; 9.4%) and normal anatomy restoration (19; 9.4%). Conclusions Our findings demonstrate that there is acceptable revisional rate after OAGB/MGB and conversion to RYGB represents the most frequent choice. Graphical abstract

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

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.