Original articleRevisional bariatric surgery to single-anastomosis gastric bypass: a large multi-institutional series
Section snippets
Methodology and setting
Operations were performed by multiple surgeons at 1 public (government-funded) and 2 private hospitals in Brisbane, Australia. Patients were identified through a retrospective review of a prospectively maintained database, from our first rSAGB in 2012 to 2019. Medical records were reviewed, and phone surveys were then performed. Adult patients older than 18 years that underwent rSAGB were included for analysis. Ethics approval was formally obtained from the hospital ethics boards. The assessed
Results
During the study period, 254 patients underwent rSAGB (225 females [88%]; mean age: 47.6 yr, range: 21–71 yr). The primary procedures were laparoscopic adjustable gastric banding (LAGB; n = 233 [91%]) and sleeve gastrectomies (SG; n = 21 [8%]). Indications for rSAGB are listed in Table 1. The most common was inadequate weight loss or weight regain (n = 171 [67%]). Of the LAGB revision cases, 76% (n = 177) used a single-stage procedure (i.e., removal of the LAGB and rSAGB in the same procedure).
Discussion
This series of 254 patients is, to our knowledge, the largest reported series of rSAGB to date, with a large proportion of patients with follow-ups beyond 1 year (72%). We had a good response rate to the patient-satisfaction and reflux survey (87 patients; 34%). Our perioperative morbidity rate and the proportion of patients with an early need for reintervention were low.
While our weight loss outcomes in this revisional context were favorable, reflux was a serious problem for a large proportion
Conclusion
Revisional bariatric surgery to SAGB is feasible and safe, with high patient satisfaction, good short-term weight loss outcomes, and low major complication rates. In our series, severe postoperative reflux after revision was a substantial problem, with a significant number of patients requiring long-term PPI use and late rerevision. Other institutions that perform this revisional procedure should publish their results and include formal and detailed analyses of reflux rates. Documentation of
Acknowledgments
We are indebted to Katherine Bradley, Senior Clinical Nurse, for her efforts in coordinating the bariatric service at our institution and maintenance of records that allowed us to identify the patients easily.
Disclosures
The authors have no commercial associations that might be a conflict of interest in relation to this article.
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