Skip to main content
SpringerLink
Log in

Medium and Long-Term Weight Loss After Revisional Bariatric Surgery: A Systematic Review and Meta-Analysis

  • Review
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Despite the current increase in revisional bariatric surgery (RBS), data on the sustainability of weight loss remain unclear. A systematic review and meta-analysis were performed to assess weight loss outcomes in adult patients undergoing RBS with follow-up > 2 years. Twenty-eight observational studies (n = 2213 patients) were included. The %TWL was 27.2 (95%CI = 23.7 to 30.6), and there was a drop in BMI of 10.2 kg/m2 (95%CI =  − 11.6 to − 8.7). The %EWL was 54.8 (95%CI = 47.2 to 62.4) but with a high risk of publication bias (Egger’s test = 0.003). The overall quality of evidence was very low. Our data reinforce that current evidence on RBS is mainly based on low-quality observational studies, and further higher-quality studies are needed to support evidence-based practice.

Graphical Abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Perdomo CM, Cohen RV, Sumithran P, et al. Contemporary medical, device, and surgical therapies for obesity in adults. Lancet. 2023;401(10382):1116–30. https://doi.org/10.1016/S0140-6736(22)02403-5.

    Article  PubMed  Google Scholar 

  2. Brethauer SA, Kothari S, Sudan R, et al. Systematic review on reoperative bariatric surgery: American Society for Metabolic and Bariatric Surgery Revision Task Force. Surg Obes Relat Dis. 2014;10(5):952–72. https://doi.org/10.1016/j.soard.2014.02.014.

    Article  PubMed  Google Scholar 

  3. Clapp B, Ponce J, DeMaria E, et al. American Society for Metabolic and Bariatric Surgery 2020 estimate of metabolic and bariatric procedures performed in the United States. Surg Obes Relat Dis. 2022;18(9):1134–40. https://doi.org/10.1016/j.soard.2022.06.284.

    Article  PubMed  Google Scholar 

  4. Brown W, Liem R, Shikora S, et al. 8th IFSO global registry report. International federation for the surgery of obesity and metabolic disorders. 2023. Available from: https://www.ifso.com/pdf/8th-ifso-registry-report-2023.pdf. Accessed 3 Jan 2024.

  5. Majid SF, Davis MJ, Ajmal S, et al. Current state of the definition and terminology related to weight recurrence after metabolic surgery: review by the POWER Task Force of the American Society for Metabolic and Bariatric Surgery. Surg Obes Relat Dis. 2022;18(7):957–63. https://doi.org/10.1016/j.soard.2022.04.012.

    Article  PubMed  Google Scholar 

  6. Dang JT, Vaughan T, Mocanu V, et al. Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: indications, prevalence, and safety. Obes Surg. 2023;33(5):1486–93. https://doi.org/10.1007/s11695-023-06546-x.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Mok J, Adeleke MO, Brown A, et al. Safety and efficacy of liraglutide, 3.0 mg, once daily vs placebo in patients with poor weight loss following metabolic surgery: the BARI-OPTIMISE randomized clinical trial. JAMA Surg. 2023;158(10):1003–11. https://doi.org/10.1001/jamasurg.2023.2930.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Vanetta C, Dreifuss NH, Schlottmann F, et al. Bariatric surgery conversions in MBSAQIP centers: current indications and outcomes. Obes Surg. 2022;32(10):3248–56. https://doi.org/10.1007/s11695-022-06229-z.

    Article  PubMed  Google Scholar 

  9. Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery [published correction appears in Obes Surg. 2022 Nov 29]. Obes Surg. 2023;33(1):3–14. https://doi.org/10.1007/s11695-022-06332-1.

  10. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339(1):b2535.

    Article  PubMed  PubMed Central  Google Scholar 

  11. The Cochrane Collaboration. Review Manager (RevMan). Version 5.4 [Computer program]. 2020 [cited 2002 Nov]. Available from https://training.cochrane.org/online-learning/core-software-cochrane-reviews/revman.

  12. R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. 2023. Avaliable in: https://www.R-project.org. Accessed 13 Apr 2023.

  13. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;15(21):1539–58. https://doi.org/10.1002/sim.1186.

    Article  Google Scholar 

  14. Egger M, Davey-Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;13(315):629–34. https://doi.org/10.1136/bmj.315.7109.629.

    Article  Google Scholar 

  15. McMaster University (developed by Evidence Prime, Inc.). GRADEpro GDT: GRADEpro Guideline Development Tool [Software]. 2022 (cited 2022 Nov). Available from https://gradepro.org.

  16. Moola S, Munn Z, Tufanaru C, et al. Chapter 7: Systematic reviews of etiology and risk. In: Aromataris E, Munn Z (Editors). Joanna Briggs Institute Reviewer’s Manual. The Joanna Briggs Institute, 2017. Available from https://reviewersmanual.joannabriggs.org/. Accessed Aug 2023.

  17. Abu-Abeid A, Goren O, Abu-Abeid S, et al. One anastomosis gastric bypass for revision of restrictive procedures: mid-term outcomes and analysis of possible outcome predictors. Obes Surg. 2022;32(10):3264–71.

    Article  PubMed  Google Scholar 

  18. Angrisani L, Vitiello A, Santonicola A, et al. Roux-en-Y gastric bypass versus sleeve gastrectomy as revisional procedures after adjustable gastric band: 5-year outcomes. Obes Surg. 2017;27(6):1430–7.

    Article  PubMed  Google Scholar 

  19. Bruzzi M, Voron T, Zinzindohoue F, et al. Revisional single-anastomosis gastric bypass for a failed restrictive procedure: 5-year results. Surg Obes Relat Dis. 2016;12(2):240–5.

    Article  PubMed  Google Scholar 

  20. Cariani S, Agostinelli L, Leuratti L, et al. Bariatric revisionary surgery for failed or complicated vertical banded gastroplasty (VBG): comparison of VBG reoperation (re-VBG) versus Roux-en-Y gastric bypass-on-VBG (RYGB-on-VBG). J Obes. 2010;2010:206249.

    Article  PubMed  Google Scholar 

  21. Caruana JA, Monte SV, Jacobs DM, et al. Distal small bowel bypass for weight regain after gastric bypass: safety and efficacy threshold occurs at <70% bypass. Surg Obes Relat Dis. 2015;11(6):1248–55.

    Article  PubMed  Google Scholar 

  22. Dakour-Aridi HN, Wehbe MR, Shamseddine G, et al. Long-term outcomes of Roux-en-Y gastric bypass conversion of failed laparoscopic gastric band. Obes Surg. 2017;27(6):1401–8.

    Article  PubMed  Google Scholar 

  23. Dardamanis D, Navez J, Coubeau L, et al. A retrospective comparative study of primary versus revisional Roux-en-Y gastric bypass: long-term results. Obes Surg. 2018;28(8):2457–64.

    Article  PubMed  Google Scholar 

  24. Delko T, Köstler T, Peev M, et al. Revisional versus primary Roux-en-Y gastric bypass: a case-matched analysis. Surg Endosc. 2014;28(2):552–8.

    Article  PubMed  Google Scholar 

  25. Di Betta E, Mittempergher F, Di Fabio F, et al. Duodenal switch without gastric resection after failed gastric restrictive surgery for morbid obesity. Obes Surg. 2006;16(3):258–61.

    Article  PubMed  Google Scholar 

  26. El-Sayes IA, Abdelbaki TN, Elkeleny MR, et al. Feasibility and efficacy of laparoscopic sleeve gastrectomy as a revisional procedure after failed gastric plication in morbidly obese patients. J Laparoendosc Adv Surg Tech A. 2021;31(3):284–9.

    Article  PubMed  Google Scholar 

  27. Emous M, Apers J, Hoff C, et al. Conversion of failed laparoscopic adjustable gastric banding to Roux-en-Y gastric bypass is safe as a single-step procedure. Surg Endosc. 2015;29(8):2217–23.

    Article  CAS  PubMed  Google Scholar 

  28. Felsenreich DM, Steinlechner K, Langer FB, et al. Outcome of sleeve gastrectomy converted to Roux-en-Y gastric bypass and one-anastomosis gastric bypass. Obes Surg. 2022;32(3):643–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Hedberg J, Gustavsson S, Sundbom M. Long-term follow-up in patients undergoing open gastric bypass as a revisional operation for previous failed restrictive procedures. Surg Obes Relat Dis. 2012;8(6):696–701.

    Article  PubMed  Google Scholar 

  30. Kermansaravi M, Karami R, Valizadeh R, et al. Five-year outcomes of one anastomosis gastric bypass as conversional surgery following sleeve gastrectomy for weight loss failure. Sci Rep. 2022;12(1):10304. https://doi.org/10.1038/s41598-022-14633-9.

  31. Kraljević M, Süsstrunk J, Köstler T, et al. Short or long biliopancreatic limb bypass as a secondary procedure after failed laparoscopic sleeve gastrectomy. Obes Surg. 2021;31(1):170–8.

    Article  PubMed  Google Scholar 

  32. Lazaridis II, Kraljević M, Süsstrunk J, et al. Revisional adjustable gastric band in Roux-en-Y gastric bypass-is it worth it. J Gastrointest Surg. 2021;25(12):3056–63.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Liagre A, Martini F, Anduze Y, et al. Efficacy and drawbacks of single-anastomosis duodeno-ileal bypass after sleeve gastrectomy in a tertiary referral bariatric center. Obes Surg. 2021;31(6):2691–700.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Lourensz K, Himantoko I, Shaw K, et al. Long-term outcomes of revisional malabsorptive bariatric surgery: do the benefits outweigh the risk? Obes Surg. 2022;32(6):1822–30.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Nevo N, Lessing Y, Abu-Abeid S, et al. Roux-en-Y gastric bypass versus one anastomosis gastric bypass as a preferred revisional bariatric surgery after a failed silastic ring vertical gastroplasty. Obes Surg. 2021;31(2):654–8.

    Article  PubMed  Google Scholar 

  36. Ortega-Serrano J, Kraus-Fischer G, Alfonso-Ballester R, et al. Shortening of the common channel as a rescue surgery after gastric bypass failure. Obes Surg. 2020;30(12):4760–7.

    Article  PubMed  Google Scholar 

  37. Perry ZH, Zioni T, Netz U, et al. A comparison of one- and two-stage laparoscopic sleeve gastrectomy following failed laparoscopic adjustable gastric banding using the BAROS score. Obes Surg. 2022;32(4):1243–50.

    Article  PubMed  Google Scholar 

  38. Pizza F, D’Antonio D, CarbonellAsíns JA, et al. One anastomosis gastric bypass after sleeve gastrectomy failure: does a single procedure fit for all. Obes Surg. 2021;31(4):1722–32.

    Article  PubMed  Google Scholar 

  39. Rayman S, Assaf D, Azran C, et al. Sleeve gastrectomy failure-revision to laparoscopic one-anastomosis gastric bypass or Roux-n-Y gastric bypass: a multicenter study. Obes Surg. 2021;31(7):2927–34.

    Article  PubMed  Google Scholar 

  40. Sarhan MD, AbdelSalam NM, Mostafa MS, et al. Laparoscopic Roux-en-Y gastric bypass after failed vertical banded gastroplasty: 2-year follow-up of 102 patients. Obes Surg. 2021;31(6):2717–22.

    Article  PubMed  Google Scholar 

  41. Shimon O, Keidar A, Orgad R, et al. Long-term effectiveness of laparoscopic conversion of sleeve gastrectomy to a biliopancreatic diversion with a duodenal switch or a Roux-en-Y gastric bypass due to weight loss failure. Obes Surg. 2018;28(6):1724–30.

    Article  PubMed  Google Scholar 

  42. van Gemert WG, van Wersch MM, Greve JW, et al. Revisional surgery after failed vertical banded gastroplasty: restoration of vertical banded gastroplasty or conversion to gastric bypass. Obes Surg. 1998;8(1):21–8.

    Article  PubMed  Google Scholar 

  43. Westling A, Ohrvall M, Gustavsson S. Roux-en-Y gastric bypass after previous unsuccessful gastric restrictive surgery. J Gastrointest Surg. 2002;6(2):206–11.

    Article  PubMed  Google Scholar 

  44. Yazbek T, Safa N, Denis R, et al. Laparoscopic sleeve gastrectomy (LSG)-a good bariatric option for failed laparoscopic adjustable gastric banding (LAGB): a review of 90 patients. Obes Surg. 2013;23(3):300–5.

    Article  PubMed  Google Scholar 

  45. Berti LV, Campos J, Ramos A, et al. Position of the SBCBM – nomenclature and definition of outcomes of bariatric and metabolic surgery. Arq Bras Cir Dig. 2015;28 Suppl 1(Suppl 1):2. https://doi.org/10.1590/S0102-6720201500S100002.

    Article  PubMed  Google Scholar 

  46. Grover BT, Morell MC, Kothari SN, et al. Defining weight loss after bariatric surgery: a call for standardization. Obes Surg. 2019;29(11):3493–9. https://doi.org/10.1007/s11695-019-04022-z.

    Article  PubMed  Google Scholar 

  47. Fehervari M, Banh S, Varma P, et al. Weight loss specific to indication, remission of diabetes, and short-term complications after sleeve gastrectomy conversion to Roux-en-Y gastric bypass: a systematic review and meta-analysis. Surg Obes Relat Dis. 2023;19(4):384–95. https://doi.org/10.1016/j.soard.2022.11.004.

    Article  PubMed  Google Scholar 

  48. Matar R, Monzer N, Jaruvongvanich V, et al. Indications and outcomes of conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: a systematic review and a meta-analysis. Obes Surg. 2021;31(9):3936–46. https://doi.org/10.1007/s11695-021-05463-1.

    Article  PubMed  Google Scholar 

  49. Axer S, Lederhuber H, Stiede F, et al. Weight-related outcomes after revisional bariatric surgery in patients with non-response after sleeve gastrectomy-a systematic review. Obes Surg. 2023;33(7):2210–8. https://doi.org/10.1007/s11695-023-06630-2.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Parmar CD, Gan J, Stier C, et al. One anastomosis/mini gastric bypass (OAGB-MGB) as revisional bariatric surgery after failed primary adjustable gastric band (LAGB) and sleeve gastrectomy (SG): a systematic review of 1075 patients. Int J Surg. 2020;81:32–8. https://doi.org/10.1016/j.ijsu.2020.07.007.

    Article  PubMed  Google Scholar 

  51. Johari Y, Ooi G, Burton P, et al. Long-term matched comparison of adjustable gastric banding versus sleeve gastrectomy: weight loss, quality of life, hospital resource use and patient-reported outcome measures. Obes Surg. 2020;30(1):214–23. https://doi.org/10.1007/s11695-019-04168-w.

    Article  PubMed  Google Scholar 

  52. Dantas ACB, Branco LT, Tustumi F, et al. One-anastomosis gastric bypass versus Roux-en-Y gastric bypass as revisional surgery after sleeve gastrectomy: a systematic review and meta-analysis. Obes Surg. 2022;32(12):4082–8. https://doi.org/10.1007/s11695-022-06326-z.

    Article  PubMed  Google Scholar 

  53. Karmali S, Brar B, Shi X, et al. Weight recidivism post-bariatric surgery: a systematic review. Obes Surg. 2013;23(11):1922–33. https://doi.org/10.1007/s11695-013-1070-4.

    Article  PubMed  Google Scholar 

  54. Mahawar KK, Nimeri A, Adamo M, et al. Practices concerning revisional bariatric surgery: a survey of 460 surgeons. Obes Surg. 2018;28(9):2650–60. https://doi.org/10.1007/s11695-018-3226-8.

    Article  PubMed  Google Scholar 

  55. Giannopoulos S, Kapsampelis P, Pokala B, et al. Bariatric surgeon perspective on revisional bariatric surgery (RBS) for weight recurrence. Surg Obes Relat Dis. 2023;19(9):972–9. https://doi.org/10.1016/j.soard.2023.02.027.

    Article  PubMed  Google Scholar 

  56. Bastos EL, Viegas F, Valezi AC, et al. Long- and very long-term unfavorable outcomes of the laparoscopic adjustable gastric band in the surgical approach of morbid obesity: a systematic review and meta-analysis. J Bariatr Surg. 2023;2:3–12. https://doi.org/10.4103/jbs.jbs_10_22.

    Article  Google Scholar 

  57. Puzziferri N, Roshek TB 3rd, Mayo HG, et al. Long-term follow-up after bariatric surgery: a systematic review. JAMA. 2014;312(9):934–42. https://doi.org/10.1001/jama.2014.10706.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Dettori JR. Loss to follow-up. Evid Based Spine Care J. 2011;2(1):7–10. https://doi.org/10.1055/s-0030-1267080.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Marília School of Medicine, Marília, Brazil

    Eduardo L. S. Bastos

  2. Department of Surgery and Anatomy, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil

    Wilson Salgado Jr.

  3. Bariatric and Metabolic Surgery Unit, University of São Paulo, São Paulo, Brazil

    Anna C. B. Dantas

  4. Department of Surgery, Federal University of Santa Catarina, Florianópolis, Brazil

    Tiago R. Onzi

  5. University College London Hospitals NHS Foundation Trust, London, UK

    Lyz B. Silva

  6. Bariatric and Metabolic Service, Santa Casa de Misericórdia de Itabuna, Bahia, Brazil

    Álvaro Albano

  7. Department of Evidence Based Medicine, Lusíada University Center, Santos, Brazil

    Luca S. Tristão & Clara L. dos Santos

  8. Brazilian Medical Association Guideline Group, São Paulo, Brazil

    Antonio Silvinato

  9. University of São Paulo, São Paulo, Brazil

    Wanderley M. Bernardo

Authors
  1. Eduardo L. S. Bastos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wilson Salgado Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anna C. B. Dantas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tiago R. Onzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lyz B. Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Álvaro Albano
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Luca S. Tristão
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Clara L. dos Santos
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Antonio Silvinato
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Wanderley M. Bernardo
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

For the Scientific Committee of the Brazilian Society of Bariatric and Metabolic Surgery (SBCBM)

Contributions

All authors approved the manuscript.

Corresponding author

Correspondence to Eduardo L. S. Bastos.

Ethics declarations

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

For this type of study, formal consent is not required.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Key Points

• Revisional bariatric surgery (RBS) has been growing steadily worldwide, mainly due to a non-negligible rate of failure to control obesity in the long term.

• Available data on medium- and long-term outcomes of RBS are limited and inconclusive.

• Despite the low quality of evidence, RBS appears to show encouraging, but not definitive, results in relation to weight-related outcomes in the medium and long term.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bastos, E.L.S., Salgado, W., Dantas, A.C.B. et al. Medium and Long-Term Weight Loss After Revisional Bariatric Surgery: A Systematic Review and Meta-Analysis. OBES SURG 34, 1917–1928 (2024). https://doi.org/10.1007/s11695-024-07206-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-024-07206-4

Keywords

Search

Navigation