Embracing the second chance: efficacy and safety of revisional bariatric surgery for weight regain

Abstract

Aim: Weight recidivism following bariatric surgery has major physical and psychological consequences. Revisional surgery is a common management option but is associated with increased complications compared to primary surgery. The objective of this study was to assess the efficacy and safety of revisional bariatric surgery for weight regain at our institution.

Methods: A retrospective database review identified patients who underwent revisional bariatric surgery for weight regain at our institution from 2014 to 2023. Emergent operations were excluded. The primary outcomes were percentage total (%TWL) and excess weight loss (%EWL) using revisional surgery weight as the baseline. Secondary outcomes were 30-day morbidity, mortality, readmission, and reoperation rates.

Results: Seventy patients were identified. Five types of revisional procedures were performed: 39 (55.7%) Roux-en-Y gastric bypass (RYGB) revisions (21 endoscopic, 11 laparoscopic, 6 robotic, 1 open), 15 (21.4%) sleeve gastrectomy (SG) to one-anastomosis gastric bypass (OAGB) conversions (8 robotic, 7 laparoscopic), 8 (11.4%) SG revisions (7 laparoscopic, 1 robotic), 7 (10.0%) laparoscopic gastric band to SG conversions, and 1 (1.4%) laparoscopic gastric band to OAGB conversion. SG to OAGB conversion had the largest mean 12-month %EWL at 67.9 ± 25.1, which was significantly greater than SG revision at 47.4 ± 6.7 (P = 0.04) and gastric band to SG conversion at 44.1 ± 21.1 (P = 0.04). SG to OAGB conversion also had the largest mean 12-month %TWL at 19.1 ± 9.4, significantly greater than RYGB revision at 9.0 ± 6.0 (P < 0.001). The 30-day morbidity rate for all patients was 7.1% (N = 5), including 1 anastomotic leak following an SG revision requiring 1 reoperation (1.4%). The 30-day readmission rate was 5.7% (N = 4) and there were no 30-day mortalities.

Conclusion: Revisional bariatric surgery is an effective tool for addressing weight regain and achieving sustained weight loss. Among the revisional options, converting SG to OAGB was most effective at promoting significant weight loss at 12 months. These findings highlight the important role of tailored revisional procedures in the broader context of bariatric care.

Keywords

Revisional bariatric surgery / weight regain / gastric bypass / sleeve gastrectomy

References

[1] Magro DO,Delfini R,Callejas F.Long-term weight regain after gastric bypass: a 5-year prospective study.Obes Surg2008;18:648-51

[2] Christou NV,Maclean LD.Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years.Ann Surg2006;244:734-40 PMCID:PMC1856611

[3] Adams TD,Litwin SE.Weight and metabolic outcomes 12 years after gastric bypass.N Engl J Med2017;377:1143-55 PMCID:PMC5737957

[4] David LA,Cassin SE.Preoperative and post-operative psychosocial interventions for bariatric surgery patients: a systematic review.Obes Rev2020;21:e12926

[5] Thonney B,Badel S,Golay A.The relationship between weight loss and psychosocial functioning among bariatric surgery patients.Am J Surg2010;199:183-8

[6] Jensen AB,Aczél S.Efficacy of the glucagon-like peptide-1 receptor agonists liraglutide and semaglutide for the treatment of weight regain after bariatric surgery: a retrospective observational study.Obes Surg2023;33:1017-25 PMCID:PMC9918402

[7] Coakley BA,Spight DH.Revisional bariatric surgery for failed restrictive procedures.Surg Obes Relat Dis2008;4:581-6

[8] Cheema F,Moran-Atkin E,Choi J.Outcomes in revisional bariatric surgery: a high-volume single institution experience.Surg Endosc2021;35:3932-9

[9] Himpens J,Cadière GB,Greve JW.Long-term results of laparoscopic Roux-en-Y Gastric bypass: evaluation after 9 years.Obes Surg2012;22:1586-93

[10] Ponce J,Nguyen NT,Sudan R.American Society for Metabolic and Bariatric Surgery estimation of bariatric surgery procedures in 2015 and surgeon workforce in the United States.Surg Obes Relat Dis2016;12:1637-9

[11] Clapp B,DeMaria E.American Society for Metabolic and Bariatric Surgery 2020 estimate of metabolic and bariatric procedures performed in the United States.Surg Obes Relat Dis2022;18:1134-40

[12] Switzer NJ,Gill RS.Revisional bariatric surgery.Surg Clin North Am2016;96:827-42

[13] Finkelstein EA,Thompson H.Obesity and severe obesity forecasts through 2030.Am J Prev Med2012;42:563-70

[14] Lauti M,Zeng ISL,Hill AG.Definition determines weight regain outcomes after sleeve gastrectomy.Surg Obes Relat Dis2017;13:1123-9

[15] Lauti M,Hill AG.Weight regain following sleeve gastrectomy - a systematic review.Obes Surg2016;26:1326-34

[16] Cooper TC,Webb K,Kushner RF.Trends in weight regain following Roux-en-Y gastric bypass (RYGB) bariatric surgery.Obes Surg2015;25:1474-81

[17] Tran DD,Purnell S.Revision of Roux-En-Y gastric bypass for weight regain: a systematic review of techniques and outcomes.Obes Surg2016;26:1627-34

[18] Matar R,Jaruvongvanich V.Indications and outcomes of conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: a systematic review and a meta-analysis.Obes Surg2021;31:3936-46

[19] Boru CE,Giustacchini P,Silecchia G.Short-term outcomes of sleeve gastrectomy conversion to R-Y gastric bypass: multi-center retrospective study.Langenbecks Arch Surg2018;403:473-9

[20] Kichler K,DeMaria E.Reoperative surgery for nonresponders and complicated sleeve gastrectomy operations in patients with severe obesity. An international expert panel consensus statement to define best practice guidelines.Surg Obes Relat Dis2019;15:173-86

[21] Merz AE,Gagner M.Duodenal switch in revisional bariatric surgery: conclusions from an expert consensus panel.Surg Obes Relat Dis2019;15:894-9

[22] Kermansaravi M,DavarpanahJazi AH.One anastomosis/mini-gastric bypass (OAGB/MGB) as revisional surgery following primary restrictive bariatric procedures: a systematic review and meta-analysis.Obes Surg2021;31:370-83 PMCID:PMC7809003

[23] Pizza F,Lucido FS.The role of ursodeoxycholic acid (UDCA) in cholelithiasis management after one anastomosis gastric bypass (OAGB) for morbid obesity: results of a monocentric randomized controlled trial.Obes Surg2020;30:4315-24

[24] Nasta AM, Goel R, Singhal R, et al; BROAD study collaborative group. 30-day morbidity and mortality of revisional bariatric surgery - an international multi-centre collaborative (BROAD) study. Obes Res Clin Pract. 2024;18:195-200.

[25] Spyropoulos C,Panagiotopoulos S,Kalfarentzos F.Revisional bariatric surgery: 13-year experience from a tertiary institution.Arch Surg2010;145:173-7

[26] Spurzem GJ,Kunkel EK.Robotic bariatric surgery reduces morbidity for revisional gastric bypass when compared to laparoscopic: outcome of 8-year MBSAQIP analysis of over 40,000 cases.Surg Endosc2024;38:6294-304 PMCID:PMC11525439

[27] Abboud DM,Rapaka B,Ghanem OM.Endoscopic management of weight recurrence following bariatric surgery.Front Endocrinol2022;13:946870 PMCID:PMC9329792

[28] Noria SF,Atkins KD,Gadde KM.Weight regain after bariatric surgery: scope of the problem, causes, prevention, and treatment.Curr Diab Rep2023;23:31-42 PMCID:PMC9906605

[29] Pratama KG,Hengky A,Pauliana P.Glucagon-like peptide-1 receptor agonists for post-bariatric surgery weight regain and insufficient weight loss: a systematic review.Obes Med2024;46:100533

[30] Müller TD,Tschöp MH.Anti-obesity drug discovery: advances and challenges.Nat Rev Drug Discov2022;21:201-23 PMCID:PMC8609996