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Weight Loss Outcome of Revisional Bariatric Operations Varies According to the Primary Procedure

Brolin, Robert E. MD, FACS*; Cody, Ronald P. EdD†

doi: 10.1097/SLA.0b013e3181820cdf
Original Articles

Background: Revisional bariatric operations performed for weight loss failure are frequently associated with inconsistent weight reduction and serious perioperative complications.

Methods: Outcomes of 151 consecutive revisional operations performed by one surgeon for unsatisfactory weight loss were compared to determine whether postoperative weight loss is influenced by the type of primary procedure. Minimum follow-up was 12 months.

Results: Primary operations included 14 jejunoileal bypass (JIB): one revised to gastroplasty, 13 to RY gastric bypass; 71 gastroplasty/banding (GP/B): all revised to Roux-en-Y gastric bypass (RYGB); and 66 gastric bypass: 49 revised to distal/malabsorptive RYGB, 12 restapled without malabsorption, and 5 loop bypasses revised to standard RYGB. Perioperative morbidity/mortality rates were 21.8% and 1.3%, respectively. Follow-up at 12 months was 93%. Mean weight/body mass index unit loss after revision of JIB was 90 pounds/17 units versus 113 pounds/16 units after revision of GP/B and 71 pounds/11 units after revision of gastric bypass (P ≤ 0.05) with corresponding mean percent of excess weight loss of 51% for JIB, 56% for GP/B, and 48% for gastric bypass. Five of the JIB revisions (38%) lost ≥50% excess weight loss versus 39 of the GP/B revisions (61%) and 28 of the gastric bypass revisions (48%). Comorbidities improved/resolved in 100% of those who lost ≥50% of excess weight versus 89% who did not.

Conclusions: Weight loss after revision of pure restrictive operations is significantly better than after revision of operations with malabsorptive components. Improvement of comorbidities in the great majority of patients justifies revision of all types of bariatric operations for unsatisfactory weight loss.

Revision of 151 primary bariatric operations including 14 jejunoileal bypasses, 71 pure restrictive procedures, and 66 gastric bypasses was performed for weight loss failure. Post-revisional weight loss was significantly greater after revision of failed restrictive operations to Roux-en-Y gastric bypass versus weight loss after revision of failed gastric bypass by adding malabsorption. Comorbidities improved or resolved in 95% of patients after revision.

From the *Department of Surgery, University Medical Center at Princeton, Princeton, New Jersey; and †Department of Public Health, UMDNJ Robert Wood Johnson Medical School, Piscataway, New Jersey.

Reprints are not available.

Correspondence: Robert E. Brolin, MD, New Jersey Bariatrics, 666 Plainsboro Road, Bldg. 600, Suite #640, Princeton, NJ 08540. E-mail: rbrolin@njbariatricspc.com.

© 2008 Lippincott Williams & Wilkins, Inc.