Revisional bariatric surgery due to failure of the initial technique: 25 years of experience in a specialized Unit of Obesity Surgery in Spain

Abstract

Objectives: To evaluate the effectiveness of conversion surgery in a bariatric surgery unit with 25years of experience.

Method: Retrospective observational study of patients with typeII obesity or higher who were reoperated by means of conversion surgery due to weight regain, residual body mass index (BMI)>35kg/m² or <50% of excess weight loss. The demographic and anthropometric data, comorbidities and perioperative data were analyzed in 5 periods of time: initial, post-surgery1, pre-surgery2, post-surgery2 and current.

Results: A total of 112 patients were included, with a mean age of 40.2years, who initially underwent vertical banded gastroplasty (VBG) (32.1%), gastric banding (GB) (23.2%), Roux-en-Y gastric bypass (RYGB) (21.4%) and sleeve gastrectomy (SG) (23.2%). The conversion techniques, with a median time between the two surgeries of 70months, included: RYGB, SG, one-anastomosis gastric bypass (OAGB), shortening of the common loop (SCL) and biliopancreatic diversion (BPD). There was a reduction of the initial weight from 144.2±30.3 to 101.5±21.8kg after surgery-1; from 115.6±24.0 to 91.5±19.0kg after surgery-2. The weight at present is 94.7±16.4kg, with a median follow-up of 27.5months. Similar results were seen with the BMI. The improvement of comorbidities mainly occurred after the first intervention.

Conclusions: Conversion surgery causes a weight reduction that does not exceed the loss achieved after the first surgery; however, it does manage to stabilize weight over time. The perioperative morbidity rate is acceptable and would justify its application, despite the limited impact on comorbidities.

Keywords: Bariatric surgery; Cirugía bariátrica; Cirugía de revisión; Conversion surgery; Insufficient weight loss; Obesidad; Obesity; Pérdida insuficiente; Regain of weight; Reganancia de peso.