Weight-Loss Surgery and Type 2 Diabetes Is bariatric surgery a shortcut to a "cure"? (Also, Beth's in a magazine!)
How to REVERSE Severe Hyperinsulinemic Hypoglycemia after Gastric Bypass?!

Revisional Bariatric Surgery Appears Safe

Revisional Bariatric Surgery 13-Year Experience From a Tertiary Institution

Charalambos Spyropoulos, MDIoannis Kehagias, MDSpyros Panagiotopoulos, MDNancy Mead, MSFotis Kalfarentzos, MD Arch Surg. 2010;145(2):173-177.

Objective  To evaluate the safety and effectiveness of revisional bariatric surgery at a tertiary institution. Revisional bariatric operations for unsuccessful weight loss or intolerable complications following the primary intervention are increasing.

Design 

 Case series from a prospective database.

Setting  Tertiary bariatric referral center.

Patients  From 1995 to 2008, 56 patients who had been formerly operated on for clinically severe obesity underwent a revisional procedure at our institution. Their mean (SD) age and body mass index were 39.6 (9.6) years and 46.9 (16.4), respectively. They were divided into 3 groups according to the indications for reoperation: (1) unsatisfactory weight loss (n = 39), (2) severe nutritional complications (n = 15), and (3) intolerable adverse effects (n = 2).

Main Outcome Measures  Effectiveness of the procedures according to the indication of revision and overall morbidity and mortality rates.

Results  Mean (SD) follow-up was 102 (8) months. There was no mortality but there was an early morbidity rate of 33.9% due to postoperative complications, including 2 cases of acute renal failure (3.6%), 5 anastomotic leaks (13.1%), 8 cases of pneumonia (14.3%), and 1 case each of wound infection, incisional dehiscence, bile leak, and small-bowel obstruction (1.8%). Late complications included stenosis of the gastrojejunal anastomosis in 2 patients (3.6%), hypoalbuminemia in 2 patients (3.6%), and incisional herniation in 9 patients (16.1%). Late morbidity was 23.2%.

Conclusion  Although revisional bariatric surgery is associated with higher risk of perioperative complications compared with the primary procedures, it appears to be safe and effective when performed in experienced centers.

comments powered by Disqus