Original article
Revisional bariatric surgery to single-anastomosis gastric bypass: a large multi-institutional series

https://doi.org/10.1016/j.soard.2021.01.020Get rights and content

Highlights

  • Many patients require revisional surgery following bariatric procedures. Indications and choice of procedure are controversial

  • We present the largest series to date of revision to single-anastomosis gastric bypass

  • Weight loss outcomes were excellent and morbidity was low, especially for revision surgery

  • Unfortunately, a high rate of intractable reflux was observed, leading to a high rate of re-revision

Abstract

Background

Reoperation is often required after bariatric procedures. Single-anastomosis gastric bypass (SAGB) is increasingly utilized as a primary bariatric procedure. Few series document SAGB as a revisional bariatric procedure.

Objectives

To describe our short-term experience with revisional SAGB, focusing on weight loss and reflux symptom outcomes.

Setting

Three hospitals in Australia with both private and public (government funded) patients.

Methods

We reviewed all revisional SAGB cases from 2012 to 2019 at. Complications were considered significant if they were Clavien-Dindo grade 3a or higher. A phone survey was conducted to assess weight loss outcomes, patient satisfaction, reflux symptoms, and other complications.

Results

We identified 254 patients who had a revisional bariatric procedure to SAGB (21 previous sleeve gastrectomies and 233 previous adjustable bands), with a mean follow-up of 22 ± 15.6 months (range, 1–55 mo). The mean percentage of excess weight loss was 77% (183 patients, 72%), and the number of patients with follow-ups at 1 and 4 years was 184 (73%) and 35 patients (14%). Within 30 days, there were 29 patients (11%) who required reinterventions (21 endoscopies, 1 interventional radiology procedure, and 7 reoperations) with no deaths. Beyond 30 days, 27 patients (11%) required rerevision to Roux-en-Y gastric bypass for reflux symptoms and 10 (4%) required a laparotomy or laparoscopy for another reason (e.g., bowel obstruction). At a median follow-up of 36.6 months, 87 patients (34%) completed a phone survey, 45 (52%) of whom were taking proton pump inhibitors and 66 patients (76%) of whom were satisfied with their experience.

Conclusion

In our series, revision to SAGB was safe, with low short-term morbidity and favorable weight loss outcomes. However, beyond 1 year, a large proportion of patients experienced severe reflux symptoms and required rerevision.

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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