REVISIONAL SURGERIES
As the number of primary bariatric surgeries has increased, so has the need for revisional bariatric procedures.
Unsuccessful weight loss, weight regain and anatomic complications are the most common reasons for pursuing revisional surgery. Indications for Revision many patients who seek revisional surgery report insufficient weight loss, weight regain, an anatomic complication, or intolerable gastroesophageal reflux disease symptoms.
The ASMBS categorizes reoperation into one of three categories: Conversion, Corrective, or Reversal.
- Conversions are used for complications and inadequate response to the primary surgery
- Corrective procedures are used when primary surgeries have either poor construction or complication.
- Reversal procedures are needed when the primary surgery has caused an intolerance: such as malnutrition.
Weight gain or weight recidivism can lead to comorbid metabolic disease, and patients who experience weight regain might be good candidates for revisional surgery as well. Initial responders to surgery can have late weight regain, and revision has been shown to improve glycated hemoglobin (HbA1c) levels, lower low-density lipoprotein, and triglyceride levels, and improve hypertension. The option to surgically revise these patients would be based on an examination of the risk versus benefit. A revision procedure could lead to a percentage of weight loss and disease resolution, making it a viable option for some. Revisional surgery for weight gain without comorbidities remains controversial.
The most commonly used definition of a primary bariatric surgery failure is less than 50 percent of excess weight loss with or without a body mass index greater than 35kg/m2 at 18 months postoperative.
