Elsevier

Surgery for Obesity and Related Diseases

Volume 10, Issue 5, September–October 2014, Pages 952-972
Surgery for Obesity and Related Diseases

Review article
Systematic review on reoperative bariatric surgery: American Society for Metabolic and Bariatric Surgery Revision Task Force☆

https://doi.org/10.1016/j.soard.2014.02.014Get rights and content

Abstract

Background

Reoperative bariatric surgery has become a common practice in many bariatric surgery programs. There is currently little evidence-based guidance regarding specific indications and outcomes for reoperative bariatric surgery. A task force was convened to review the current evidence regarding reoperative bariatric surgery. The aim of the review was to identify procedure-specific indications and outcomes for reoperative procedures.

Methods

Literature search was conducted to identify studies reporting indications for and outcomes after reoperative bariatric surgery. Specifically, operations to treat complications, failed weight loss, and weight regain were evaluated. Abstract and manuscript reviews were completed by the task force members to identify, grade, and categorize relevant studies.

Results

A total of 819 articles were identified in the initial search. After review for inclusion criteria and data quality, 175 articles were included in the systematic review and analysis. The majority of published studies are single center retrospective reviews. The evidence supporting reoperative surgery for acute and chronic complications is described. The evidence regarding reoperative surgery for failed weight loss and weight regain generally demonstrates improved weight loss and co-morbidity reduction after reintervention. Procedure-specific outcomes are described. Complication rates are generally reported to be higher after reoperative surgery compared to primary surgery.

Conclusion

The indications and outcomes for reoperative bariatric surgery are procedure-specific but the current evidence does support additional treatment for persistent obesity, co-morbid disease, and complications.

Section snippets

Evidence search strategy

MEDLINE 1996–present was queried for the following terms: “bariatrics/ or *bariatric surgery” OR “gastric bypass/ or gastroplasty/” OR “band/ banding” OR “anastomosis, roux-en-y/ or biliopancreatic diversion/ or gastrectomy/” AND “revis$.mp” OR “conver$.mp.” OR “revers$.mp.” OR “fail$.mp.” OR “Reoperation/ reop$.mp.” OR “redo / redo” OR “regain.mp. or Weight Gain/”. The search was limited to articles in the English language with human patients.

A task force comprised of private practice and

I. Treatment of insufficient weight loss or weight regain after bariatric surgery

While the majority of bariatric patients do achieve successful outcomes after their primary operation, the patients who present with insufficient weight loss, continued co-morbid disease, or weight regain after bariatric surgery represent a challenging population. This group of bariatric patients may benefit from additional surgical therapy to treat their obesity and should be thoroughly evaluated by a multidisciplinary program to determine the potential causes for their poor response. This

RYGB

Conversion. Indications for conversion of RYGB to another procedure are primarily related to weight regain or recurrence of co-morbid disease, but rare metabolic derangements of the primary operation (refractory neuroglycopenia, recalcitrant hypocalcemia with associated hypoparathyroidism, and severe malnutrition) may require conversion of RYGB to SG or BPD/DS, or original anatomy [86], [87]. These reports demonstrate technical feasibility and short-term results of these 1- or 2-stage

Conclusions and future directions

The current evidence regarding reoperative bariatric surgery includes a diverse group of patient populations and procedures. The majority of the studies are single institution case series reporting short- and medium-term outcomes after reoperative procedures. The reported outcomes after reoperative bariatric surgery are generally favorable and demonstrate that additional weight loss and co-morbidity reduction is achieved with additional therapy. The risks of reoperative bariatric surgery are

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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    This project was supported by an unrestricted educational grant by Covidien.

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