Reasons and Outcomes of Reoperative Bariatric Surgery for Failed and Complicated Procedures (Excluding Adjustable Gastric Banding)

Background The rise of bariatric surgery has lead to an increasing number of reoperations for failed bariatric procedures. The reasons and types of these operations are varied in nature and remain to be defined. Methods A retrospective review of a prospectively collected database was conducted to identify patients who underwent laparoscopic revisional surgery for non-gastric bandingrelated bariatric procedures between 2001 and 2008. Results Of 384 secondary bariatric operations, 151 reoperative procedures were performed. Twenty-six vertical banded gastroplasties (17.2%), 2 mini-gastric bypasses (1.3%), 2 non-divided bypasses (1.3%), 1 distal Roux-en- Y gastric bypass (RYGBP; 0.7%), and 2 sleeve gastrectomies (1.3%) were converted to RYGBP. Three RYGBP (2%) and four jejunoileal bypass procedures (2.6%) were reversed secondary to malnutrition. One jejunoileal bypass (0.7%) and one biliopancreatic diversion (0.7%) underwent sleeve gastrectomies. Three pre-anastomotic rings were removed due to erosion (2%). Eleven pouch trimmings (7.3%), 16 redo gastrojejunostomies (10.6%), 5 redo jejunojejunostomies (3.3%), 36 remnant gastrectomies (23.8%), and 2 gastrogastric fistula takedowns (1.3%) were performed for pouch enlargements, strictures, and gastrogastric fistulas. Thirty-six patients (23.8%) underwent a combination of these procedures. The major morbidity (13.2%) was related to leaks. Other complications included wound infection, intra-abdominal abscess formation, and trocar site hernias. The mortality rate was 2%. Conclusions Reoperative bariatric surgery is a complex and growing field in bariatric surgery. The indications for surgical reoperation can vary depending on the procedure and reason for intervention. Laparoscopy appears to be a feasible approach. Though safe, morbidity and mortality are significantly higher than in primary bariatric procedures.