Management of complications and outcomes after revisional bariatric surgery. 3-Year experience at a bariatric center of excellence

Abstract Background Laparoscopic revisional bariatric surgery (RBS) is increasingly common. A tailored decision-making process isadvocated.Inthisretrospectivestudy,wereviewedtheRBS experience of a single center, analyzing perioperative complications to provide insight into management options and midterm outcomes. Methods Records from November 2011 to March 2015 were reviewed from prospectively maintained database. Six hundredeighteenpatientsunderwentlaparoscopicbariatricprocedures; of these, 81 (13.1 %) underwent RBS. Patients with a minimum follow-up of 6 months (n=77) were evaluated. Fifty-nine underwent revised laparoscopic sleeve gastrectomy, and 18 underwent revised Roux-en-Y gastric bypass. Indications for RBS were inadequate weight loss or weight regain in 42 cases (54.5 %) and gastroesophageal reflux disease (GERD), procedure-related complications, or technical failure in 35 cases (45.5 %). Results There were no deaths or conversions to open surgery. Afterameanfollow-upof22months,bodymassindex(BMI) decreased from40.9±6.7to31.9±4.8 kg/m2, mean% excess weight loss(%EWL)was 58±24.3%,and 55.3% ofpatients had resolution of comorbidities. Eight major complications (10.4%)occurred:fiveleaksandthreeintra-abdominalhematomas. Non-surgical management succeeded in 50 % of complications. Conclusions This study confirms that RBS is challenging; a complication rate of 10 % is expected. Major surgery can be avoidedwhendevotedendoscopistsandradiologistsareavailable. Intensive follow-up after complications allows early diagnosisandtreatmentofunfavorablesequelae.RBSinduceda mean %EWL of 58 % at 2 years and resolution of comorbidities in 50 % of cases. However, the durability of these effects remains questionable. Keywords Revisionalbariatricsurgery .Morbidobesity . Leak .Fistula .Laparoscopicsurgery .Complications