LAS VEGAS– As the volume of bariatric surgery climbs sharply in response to the obesity epidemic, the need for revision procedures due to weight regain is also on the rise.
Laparoscopic revision bariatric surgery, while more technically challenging, is safe and effective, and it entails less morbidity than typically seen with open revisions, Dr. Rana M. Ballo said at the annual Minimally Invasive Surgery Week.
Dr. Ballo, a fifth-year general surgery resident at Rush University Medical Center in Chicago, presented a retrospective single-center study involving 227 patients who during 2001-2011 underwent laparoscopic revision of bariatric procedures that had failed because of weight regain. The goal of the revision bariatric surgery was to restore the restrictive component and/or add a malabsorptive component in order to improve long-term weight loss.
The patients fell into four groups. Group 1 consisted of 53 patients who initially had a laparoscopic adjustable gastric band procedure which was converted to a gastric bypass. Group 2, the largest group, initially had a Roux-en-Y gastric bypass in which the pouch eventually became dilated, which is the No. 1 cause of failure of this operation in the literature; their revision surgery entailed laparoscopic pouch reduction. The 38 patients who comprised Group 3 had a Roux-en-Y gastric bypass with subsequent pouch reduction and elongation of the biliopancreatic limb. Group 4 consisted of 17 patients who initially had a vertical banded gastroplasty – a procedure with a restrictive component only – and subsequently underwent laparoscopic conversion to a gastric bypass.
After a median follow-up of 3.9 years, Group 2 had significantly less total body weight loss than the rest of the groups, all of which had similar weight losses. On the other hand, Group 2 also had a shorter operative time and briefer average hospital length of stay than the other three groups, and it was the only group with zero complications. Still, the lengths of stay and 30-day morbidity rates across the board in this laparoscopic revision series were impressively low in comparison to those previously reported in series involving open revision, Dr. Ballo noted at the meeting presented by the Society of Laparoscopic Surgeons and affiliated societies.
There was no mortality in this study. This is one of the largest series reported to date of laparoscopic revision of failed bariatric surgery. Most prior studies have involved 30-100 patients, according to Dr. Ballo.
In the 1990s, roughly 13,000 bariatric procedures were performed annually in the United States. Today that figure is in excess of 200,000 annually.
Dr. Ballo reported having no financial conflicts with regard to this study.