1
|
Łabul M, Wysocki M, Małczak P, Matyja M, Dowgiałło-Gornowicz N, Lech P, Szymański M, Major P. The outcomes of Re-Redo bariatric surgery-results from multicenter Polish Revision Obesity Surgery Study (PROSS). Sci Rep 2024; 14:2699. [PMID: 38302523 PMCID: PMC10834407 DOI: 10.1038/s41598-024-52817-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 01/24/2024] [Indexed: 02/03/2024] Open
Abstract
The increasing prevalence of bariatric surgery has resulted in a rise in the number of redo procedures as well. While redo bariatric surgery has demonstrated its effectiveness, there is still a subset of patients who may not derive any benefits from it. This poses a significant challenge for bariatric surgeons, especially when there is a lack of clear guidelines. The primary objective of this study is to evaluate the outcomes of patients who underwent Re-Redo bariatric surgery. We conducted a retrospective cohort study on a group of 799 patients who underwent redo bariatric surgery between 2010 and 2020. Among these patients, 20 individuals underwent a second elective redo bariatric surgery (Re-Redo) because of weight regain (15 patients) or insufficient weight loss, i.e. < 50% EWL (5 patients). Mean BMI before Re-Redo surgery was 38.8 ± 4.9 kg/m2. Mean age was 44.4 ± 11.5 years old. The mean %TWL before and after Re-Redo was 17.4 ± 12.4% and %EBMIL was 51.6 ± 35.9%. 13/20 patients (65%) achieved > 50% EWL. The mean final %TWL was 34.2 ± 11.1% and final %EBMIL was 72.1 ± 20.8%. The mean BMI after treatment was 31.9 ± 5.3 kg/m2. Complications occurred in 3 of 20 patients (15%), with no reported mortality or need for another surgical intervention. The mean follow-up after Re-Redo was 35.3 months. Although Re-Redo bariatric surgery is an effective treatment for obesity, it carries a significant risk of complications.
Collapse
Affiliation(s)
- Michał Łabul
- Department of General Surgery, Specialist Hospital in Legnica, Legnica, Poland
| | - Michał Wysocki
- Department of General Surgery and Surgical Oncology, Ludwik Rydygier Memorial Hospital, Os. Złotej Jesieni 1, Cracow, Poland.
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Maciej Matyja
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Natalia Dowgiałło-Gornowicz
- Department of General, Minimally Invasive and Elderly Surgery, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Paweł Lech
- Department of General, Minimally Invasive and Elderly Surgery, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Michał Szymański
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| |
Collapse
|
2
|
Gelly G, Meunier H, Bion AL, Zamparini M, Fiant AL, Savey V, Alves A, Menahem B. Revisional surgery after restrictive surgery: midterm outcomes of a tertiary center. Surg Endosc 2023; 37:7686-7697. [PMID: 37530989 DOI: 10.1007/s00464-023-10274-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/02/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION Revisional bariatric surgery (RBS) is a challenging type of procedure for the surgeons due to its specific morbidity and efficiency. The RBS has a higher prevalence nowadays and this study may help to improve scarce data upon this specific topic. METHODS Data from 252 patients undergoing RBS after laparoscopic adjustable gastric banding (LAGB) or laparoscopic sleeve gastrectomy (LSG) between 2005 and 2019, were analyzed at 2 years of follow up. A subgroup analysis of third procedure was also performed. RESULTS Overall morbidity occurred in 35 patients (37%) in the LSG group and 40 patients (25%) in the LAGB group (p = 0.045). At 2 years of RBS, mean weight was 92.8 ± 26.7 kg, BMI was 33.1 ± 8.56 kg/m2 for patients who had RBS after LSG. When RBS was performed after LAGB, mean weight at 2 years was 90.1 ± 20.7 kg and BMI was 32.5 ± 6.45 kg/m2. TWL for RBS performed after LSG was 12.7 ± 16.4% versus 25.5 ± 10.3% after LAGB (p < 0.001). CONCLUSION RBS after LSG seems to lead to higher overall morbidity whereas RBS after LAGB lead to more perioperative issues.
Collapse
Affiliation(s)
- Gautier Gelly
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen Cedex, France
| | - Hugo Meunier
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen Cedex, France
| | - Adrien Lee Bion
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen Cedex, France
| | - Marion Zamparini
- Department of Anesthesia, University Hospital of Caen, Caen, France
| | - Anne-Lise Fiant
- Department of Anesthesia, University Hospital of Caen, Caen, France
| | - Véronique Savey
- Department of Nutrition, University Hospital of Caen, Caen, France
| | - Arnaud Alves
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen Cedex, France
- UNICAEN, INSERM, ANTICIPE, Normandie Université, 14000, Caen, France
| | - Benjamin Menahem
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen Cedex, France.
- UNICAEN, INSERM, ANTICIPE, Normandie Université, 14000, Caen, France.
| |
Collapse
|
3
|
Safety of Bariatric Surgery in Obese Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2022; 167:93-97. [PMID: 34991845 DOI: 10.1016/j.amjcard.2021.11.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 11/20/2022]
Abstract
Obesity is an independent risk factor for heart failure in patients with hypertrophic cardiomyopathy (HC). In this study, we examined national trends and early outcomes of bariatric surgery for obesity in patients with HC. Using the weighted discharge data from the National Inpatient Sample, we identified adult patients with HC who underwent elective bariatric surgery for obesity between 2011 and 2017. A total of 443 obese patients with HC were identified, and 42% (n = 185) had obstructive HC. The annual number of patients increased from 18 in 2011 to 130 in 2017. Overall, the median (interquartile range) age was 50 (43 to 57) years, and 85 patients (19%) were 60 years or older. Approximately 20% (n = 90) of the patients had heart failure at the time of operation. Atrial fibrillation was present in 83 patients (19%), and 22% (n = 95) of the cohort had a pacemaker or automatic cardiac defibrillator implanted before the operation. Laparoscopic sleeve gastrectomy (72%, n = 318) and laparoscopic Roux-en-Y gastric bypass (25%, n = 110) were the most commonly performed bariatric procedures. Overall, patients stayed in the hospital for a median (interquartile range) of 2 (1 to 2) days. During the hospital stay, there were no deaths, myocardial infarctions, or documented episodes of thromboembolism. In conclusion, bariatric surgery in patients with HC is performed more frequently in recent years and is safe and associated with few perioperative complications. Because of the impact of obesity on long-term survival, clinicians should strongly consider bariatric surgery for obese HC patients who do not respond to conservative weight loss measures.
Collapse
|
4
|
Gonzalez-Urquijo M, Hinojosa-Gonzalez DE, Gidi AGA, Hurtado Arellano S, Flores-Villalba E, Rojas-Mendez J. Revisional Roux-en-Y gastric bypass after failed gastric banding: a case-matched study. Surg Endosc 2021; 36:4815-4820. [PMID: 34708291 DOI: 10.1007/s00464-021-08825-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Revisional surgery is technically demanding and is usually associated with higher intraoperative and perioperative risks than primary procedures. The objective of this study is to compare outcomes of patients who had gastric bypass procedures performed as a rescue procedure for failed gastric banding, with those who had a primary gastric bypass. MATERIALS AND METHODS The group of patients undergoing revisional gastric bypass for failed gastric band was matched in a 1:2 ratio with control patients who underwent a primary RYGB, based on gender, score, preoperative body mass index, and comorbidities. Data were retrospectively retrieved. RESULTS Thirty one (33.3%) patients underwent band removal and gastric bypass (group A) and 62 (66.6%) only primary gastric bypass (group B). Nonsignificant differences were seen in operative time, operative bleeding, or length of stay. Complications were more frequent in group A. Postoperative weight at 12-month follow-up was greater in group A, however, not statistically significant. Changes in weight, both absolute, and percentage were not different between groups. This observation was also true for BMI, in which no significant differences were seen. Overall, mean follow-up was 16 ± 3.2 months. CONCLUSION Gastric bypass can be performed as revisional bariatric surgery, with low complication rates and acceptable outcomes, though not with the same safety as a primary procedure. Gastric bypass is a satisfactory option for patients with a failed gastric band.
Collapse
Affiliation(s)
- Mauricio Gonzalez-Urquijo
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, 64710, Monterrey, Nuevo León, Mexico.
| | - David E Hinojosa-Gonzalez
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, 64710, Monterrey, Nuevo León, Mexico
| | - Ale Gibran Alam Gidi
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, 64710, Monterrey, Nuevo León, Mexico
| | - Sofia Hurtado Arellano
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, 64710, Monterrey, Nuevo León, Mexico
| | - Eduardo Flores-Villalba
- Tecnologico de Monterrey, School of Engineering and Sciences, Av. Eugenio Garza Sada 2501 Sur, Tecnológico, 64849, Monterrey, Nuevo León, Mexico
| | - Javier Rojas-Mendez
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, 64710, Monterrey, Nuevo León, Mexico
| |
Collapse
|
5
|
Agarwal S, Bruff A, Mazzei M, Zhao H, Edwards MA. Exploring racial disparity in perioperative outcomes following revisional bariatric surgery: A case-control matched analysis. Am J Surg 2020; 221:741-748. [PMID: 32279831 DOI: 10.1016/j.amjsurg.2020.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 02/16/2020] [Accepted: 03/23/2020] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Bariatric surgery is associated with 20-30% weight recidivism. As a result, revisional bariatric operation is increasingly performed. Disparity in bariatric outcomes remains controversial and very little is known about revisional bariatric surgery outcomes in ethnic cohorts. METHODS Revisional bariatric cases were identified from the 2015 and 2016 Bariatric Surgery Accreditation and Quality Improvement Program Participant Use Data File. 1:1 case-control matching was performed and perioperative outcomes compared between racial cohorts. RESULTS 24,197 cases were analyzed, including 20.78% Black patients. At baseline, there were differences in demographics and pre-existing conditions between racial cohorts. Matched analysis compared 7,286 Black and White patients. Operative duration (p = 0.008) and length of stay (p = 0.0003) were longer in Black patients. Readmission (6.8% vs. 5.4%, p = 0.009) was higher in Black patients. Bleeding (0.82% vs. 0.38%, p = 0.02) and surgical site infection (SSI) (2.6% vs. 1.8%, p = 0.01) were higher in White patients. CONCLUSION Revisional bariatric surgery is safe. Apart from a higher rate of bleeding, SSI and readmission, outcomes were not mediated by race.
Collapse
Affiliation(s)
- Shilpa Agarwal
- Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Temple University Hospital, 3401 N Broad St, Philadelphia, PA, 19140, USA.
| | - Allison Bruff
- Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Temple University Hospital, 3401 N Broad St, Philadelphia, PA, 19140, USA.
| | - Michael Mazzei
- Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Temple University Hospital, 3401 N Broad St, Philadelphia, PA, 19140, USA.
| | - Huaqing Zhao
- Department of Clinical Science, Lewis Katz School of Medicine at Temple University, 3500 N. Broad St, Philadelphia, PA, 19104, USA.
| | - Michael A Edwards
- Department of Surgery, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA.
| |
Collapse
|
6
|
Axer S, Szabo E, Agerskov S, Näslund I. Predictive factors of complications in revisional gastric bypass surgery: results from the Scandinavian Obesity Surgery Registry. Surg Obes Relat Dis 2019; 15:2094-2100. [DOI: 10.1016/j.soard.2019.09.071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 09/02/2019] [Accepted: 09/16/2019] [Indexed: 11/25/2022]
|
7
|
Safety of Revision Sleeve Gastrectomy Compared to Roux-Y Gastric Bypass After Failed Gastric Banding: Analysis of the MBSAQIP. Ann Surg 2019; 269:299-303. [PMID: 29095195 DOI: 10.1097/sla.0000000000002559] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this study was to assess the safety of revisional surgery to laparoscopic sleeve gastrectomy (LSG) compared to laparoscopic Roux-Y gastric bypass (LRYGB) after failed laparoscopic adjustable gastric banding (LAGB). BACKGROUND The number of reoperations after failed gastric banding rapidly increased in the United States during the last several years. A common approach is band removal with conversion to another weight loss procedure such as gastric bypass or sleeve gastrectomy in a single procedure. The safety profile of those procedures remains controversial. METHODS Preoperative characteristics and 30-day outcomes from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Participant Use Files 2015 were selected for all patients who underwent a 1-stage conversion of LAGB to LSG (conv-LSG) or LRYGB (conv-LRYGB). Conv-LSG cases were matched (1:1) with conv-LRYGB patients by age (±1 year), body mass index (±1 kg/m(2)), sex, and comorbidities including diabetes, hypertension, hyperlipidemia, venous stasis, and sleep apnea. RESULTS A total of 2708 patients (1354 matched pairs) were included in the study. The groups were closely matched as intended. The mean operative time in conv-LRYGB was significantly longer in comparison to conv-LSG patients (151 ± 58 vs 113 ± 45 minutes, P < 0.001). No mortality was observed in either group. Patients after conv-LRYGB had a clinically increased anastomotic leakage rate (2.07% vs 1.18%, P = 0.070) and significantly increased bleed rate (2.66% vs 0.44%, P < 0.001). Thirty-day readmission rate was significantly higher in conv-LRYGB patients (7.46% vs 3.69%, P < 0.001), as was 30-day reoperation rate (3.25% vs 1.26%, P < 0.001). The length of hospital stay was longer in conv-LRYGB. CONCLUSIONS A single-stage conversion of failed LAGB leads to greater morbidity and higher complication rates when converted to LRYGB versus LSG in the first 30 days postoperatively. These differences are particularly notable with regards to bleed events, 30-day reoperation, 30-day readmission, operative time, and hospital stay.
Collapse
|
8
|
Pędziwiatr M, Małczak P, Wierdak M, Rubinkiewicz M, Pisarska M, Major P, Wysocki M, Karcz WK, Budzyński A. Revisional Gastric Bypass Is Inferior to Primary Gastric Bypass in Terms of Short- and Long-term Outcomes-Systematic Review and Meta-Analysis. Obes Surg 2019; 28:2083-2091. [PMID: 29748735 PMCID: PMC6018598 DOI: 10.1007/s11695-018-3300-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose Although Roux-en-Y gastric bypass (RYGB) is the main primary bariatric procedure, it has also been utilized as revisional bariatric surgery. Our aim is to compare revisionary gastric bypass with primary gastric bypass through systematic review with meta-analysis. Methods Available literature was searched for eligible studies up to December 2017. Inclusion criteria were reports on morbidity, %EWL, or diabetes remission. Secondary outcomes involved mortality, anastomotic leakage, operative time, and length of hospital stay. Random effect meta-analyses were undertaken. Results Initial search yielded 1164 references. Final meta-analysis involved 21 studies and revealed significant differences in terms of morbidity (RR1.54, p < 0.001) and EWL (WMD-19.9, p < 0.001). There were no differences in diabetes remission. Conclusion Revisionary RYGB has worse weight loss effect with greater morbidity rate than primary RYGB. Electronic supplementary material The online version of this article (10.1007/s11695-018-3300-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland. .,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland.
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Mateusz Wierdak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Mateusz Rubinkiewicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Pisarska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - W Konrad Karcz
- Department of General-, Abdominal-, Vascular-, Thoracic- and Transplantation Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| |
Collapse
|
9
|
Pujol Rafols J, Al Abbas AI, Devriendt S, Guerra A, Herrera MF, Himpens J, Pardina E, Peinado-Onsurbe J, Ramos A, Ribeiro RJDS, Safadi B, Sanchez-Aguilar H, de Vries C, Van Wagensveld B. Roux-en-Y gastric bypass, sleeve gastrectomy, or one anastomosis gastric bypass as rescue therapy after failed adjustable gastric banding: a multicenter comparative study. Surg Obes Relat Dis 2018; 14:1659-1666. [PMID: 30236443 DOI: 10.1016/j.soard.2018.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 07/30/2018] [Accepted: 08/02/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND To date, laparoscopic adjustable gastric banding remains the third most commonly performed surgical procedure for weight loss. Some patients fail to get acceptable outcomes and undergo revisional surgery at rates ranging from 7% to 60%. Roux-en-Y gastric bypass (RYGB), one anastomosis gastric bypass (OAGB), and sleeve gastrectomy (SG) are among the most common salvage options for failed laparoscopic adjustable gastric banding. OBJECTIVE To compare the outcomes of converting failed laparoscopic adjustable gastric banding to RYGB, OAGB, or SG. METHODS Data collected from 7 experienced bariatric centers around the world were retrospectively collected, reviewed, and analyzed. Final body mass index (BMI), change in BMI, percentage excess BMI loss, and major complications with particular attention to leaks, hemorrhage, and mortality were reported. RESULTS Of 1219 patients analyzed, 74% underwent RYGB, 16% underwent OAGB, and 10% underwent SG after banding failure. The mean age was 38 years (±10 yr), and 82% of patients were women. The mean follow-up was 33 months. The follow-up rate was 100%, 87%, and 52% at 1, 3, and 5 years, respectively. At the latest follow-up, percentage excess BMI loss >50% was achieved by 75% of RYGB, 85% of OAGB, and 67% of SG patients. Postoperative complications occurred in 13% of patients after RYGB, 5% after OAGB, and 15% after SG. CONCLUSION Our data show that it is possible to achieve or maintain significant weight loss with an acceptable complication rate with all 3 surgical options.
Collapse
Affiliation(s)
| | - Amr I Al Abbas
- American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Stefanie Devriendt
- AZ Sint Blasius, Dendermonde, Belgium and CHIREC Hospitals, Brussels, Belgium
| | | | - Miguel F Herrera
- Instituto Nacional de Nutrición. Centro Médico ABC, México City, México
| | - Jacques Himpens
- AZ Sint Blasius, Dendermonde, Belgium and CHIREC Hospitals, Brussels, Belgium
| | - Eva Pardina
- Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | - Julia Peinado-Onsurbe
- Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | - Almino Ramos
- GastroObeso-Center - Advanced Institute In Bariatric And Metabolic Surgery, Sao Paulo, Brazil
| | | | - Bassem Safadi
- American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | | | | | | |
Collapse
|
10
|
To What Extent Does Posthospital Discharge Chemoprophylaxis Prevent Venous Thromboembolism After Bariatric Surgery? Ann Surg 2018; 267:727-733. [PMID: 28475558 DOI: 10.1097/sla.0000000000002285] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
11
|
|
12
|
Conversion of Laparoscopic Adjustable Gastric Banding to Gastric Bypass: a Comparison to Primary Gastric Bypass. Obes Surg 2017; 28:1519-1525. [DOI: 10.1007/s11695-017-3047-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
13
|
Angrisani L, Vitiello A, Santonicola A, Hasani A, De Luca M, Iovino P. Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy as Revisional Procedures after Adjustable Gastric Band: 5-Year Outcomes. Obes Surg 2017; 27:1430-1437. [PMID: 27995516 DOI: 10.1007/s11695-016-2502-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION In 2013, a worldwide bariatric surgery survey showed that laparoscopic adjustable gastric banding (LAGB) has been abandoned in favor of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-y gastric bypass (LRYGBP). PURPOSE The aim of this study was to compare results of LRYGBP and LSG performed as a revisional procedure after LAGB. MATERIALS AND METHODS All patients converted from LAGB to LSG or to LRYGBP from January 2007 to December 2011 were included in the study. Clinical data collected were age, gender, indications for revision, complications, body mass index (BMI), and body weight at revisional procedures. Weight loss was calculated at 1, 3, and 5 years after conversion. RESULTS Fifty-one patients were included in this study, 43 females and 8 males. Twenty-four patients were converted to LRYGBP (LRYGBP group) and 27 to LSG (LSG group). Indication for conversion was weight loss failure in 34 (67%) patients and band complications in 17 (33%) patients. No significant difference in age, BMI, and body weight in the two groups was found at the time of revision. One patient converted to LRYGBP had an internal hernia; one patient initially scheduled for LSG was intraoperatively converted to LRYGBP due to staple line leak. No other major perioperative complication was observed. Follow-up rate at 5 years was 84.3% (43 patients out of 51 patients) Delta-BMI and percentage of excess weight loss (%EWL) were not significantly different in the two groups at 1, 3, and 5 years (p > 0.05). CONCLUSION LRYGBP or LSG are feasible and effective surgical options after LAGB. Satisfactory weight loss was achieved after both procedures.
Collapse
Affiliation(s)
- Luigi Angrisani
- General and Endoscopic Surgery Unit, San Giovanni Bosco Hospital, Naples, Italy
| | - Antonio Vitiello
- Department of Endocrinology, Gastroenterology and Surgery, University Hospital of Naples "Federico II", Naples, Italy.
| | - Antonella Santonicola
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Ariola Hasani
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Maurizio De Luca
- Thoracic and Abdominal Surgery Department, Montebelluna-Treviso Hospital, Montebelluna, Italy
| | - Paola Iovino
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| |
Collapse
|
14
|
Long-Term Outcomes of Roux-en-Y Gastric Bypass Conversion of Failed Laparoscopic Gastric Band. Obes Surg 2017; 27:1401-1408. [DOI: 10.1007/s11695-016-2529-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
15
|
Evaluation of the obesity surgery mortality risk score for the prediction of postoperative complications after primary and revisional laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2016; 12:1504-1512. [PMID: 27425830 DOI: 10.1016/j.soard.2016.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 02/03/2016] [Accepted: 04/01/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND The Obesity Surgery Mortality Risk Score (OS-MRS) is a validated instrument for mortality risk prediction in patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures classifying patients into low risk (class A), intermediate risk (class B), and high risk (class C). OBJECTIVES The primary aim of this study was to evaluate the accuracy of the OS-MRS in predicting postoperative complications after LRYGB. Secondarily, the postoperative complication rate between primary and revisional LRYGB was systematically analyzed. SETTING The Obesity Center Amsterdam, located in a large teaching hospital, in Amsterdam, The Netherlands. METHODS The OS-MRS was applied to a consecutive database of patients who underwent LRYGB from November 2007 onwards. Postoperative complications were scored according to the Clavien-Dindo classification. Revisional LRYGB was separately analyzed. RESULTS LRYGB was performed in 1667 patients either as a primary (81.5%) or revisional (18.5%) procedure. The majority (n = 1371, 82.2%) were female, mean age 44.6 (standard deviation 14.4) years and mean body mass index 44.2 (6.5) kg/m2. Nine hundred and four (54.2%) were OS-MRS class A, 642 class B (38.5%), and 121 (7.3%) class C. Complications occurred in 143 (10.5%) and 44 (14.2%) patients after primary and revisional surgery, respectively. In both primary and revisional LRYGB, there was no association between complications and the OS-MRS classification. Subanalysis comparing primary with revisional LRYGB found a significant association between revisional surgery and the development of severe complications (Clavien-Dindo≥3) (P = .003) and mortality (P = .017). CONCLUSION The OS-MRS was not an accurate predictor for postoperative complications in patients who underwent primary or revisional LRYGB. As in other studies, revisional surgery is an independent risk factor for the development of severe complications.
Collapse
|
16
|
Do Complications Alter Postoperative Weight Loss 1 Year After Primary and Revisional Roux-en-Y Gastric Bypass? Obes Surg 2016; 26:2213-2220. [DOI: 10.1007/s11695-016-2094-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
17
|
Fournier P, Gero D, Dayer-Jankechova A, Allemann P, Demartines N, Marmuse JP, Suter M. Laparoscopic Roux-en-Y gastric bypass for failed gastric banding: outcomes in 642 patients. Surg Obes Relat Dis 2016; 12:231-9. [DOI: 10.1016/j.soard.2015.04.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 03/17/2015] [Accepted: 04/14/2015] [Indexed: 01/01/2023]
|
18
|
Stroh C, Weiner R, Wolff S, Knoll C, Manger T. [Revisional surgery and reoperations in obesity and metabolic surgery : Data analysis of the German bariatric surgery registry 2005-2012]. Chirurg 2016; 86:346-54. [PMID: 24824002 DOI: 10.1007/s00104-014-2762-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Increasing numbers of interventions for obesity and metabolic surgery have led to an increase of primary bariatric operations as well as redo operations and revisional surgery after various primary bariatric procedures. Evidence-based guidelines for indications and choice of procedure for revisional surgery do not currently exist. AIM The spectrum of various revisional and redo operations following standard operative procedures for obesity and metabolic surgery is presented based on current data from the German bariatric surgery registry (GBSR, German nationwide survey on quality assurance in bariatric surgery) and a literature search. MATERIAL AND METHODS Since 1 January 2005, the current situation of bariatric surgery has been examined using the GBSR. All data are registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University Magdeburg. Since 2005 a total of 24,070 primary bariatric procedures, 2070 revisional procedures and 1124 redo operations were analyzed. The study evaluated 1021 revisional and 491 redo operations after gastric banding (GB), 443 redo operations after sleeve gastrectomy (SG) and 306 revisional procedures and 10 redo operations after a Roux-en-Y gastric bypass (RYGBP). RESULTS Reoperations of GB to SG were performed in 240 cases. The complication rate for GB removal and SG showed a significantly higher leakage rate for one step operations than for two step procedures of 3.3% vs. 0.0%. Conversion of GB to RYGBP was performed in 402 operations without any significant differences between one and two step approaches (1.9% vs. 2.2%). The specific complication rate in the 443 interventions in patients for conversion from SG to RYGBP was 10.8% which is higher than for primary SG (4.9%) and RYGBP (5.3%). CONCLUSION Compared with the primary surgical procedures redo operations and revisional procedures have significantly higher complication rates. The data evaluated show that strong and differentiated indications are necessary for revisional and redo operations particularly in cases of therapy or metabolic failure.
Collapse
Affiliation(s)
- C Stroh
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, SRH Wald-Klinikum Gera GmbH, Straße des Friedens 122, 07548, Gera, Deutschland,
| | | | | | | | | | | |
Collapse
|
19
|
O'Toole P, Maltenfort MG, Chen AF, Parvizi J. Projected Increase in Periprosthetic Joint Infections Secondary to Rise in Diabetes and Obesity. J Arthroplasty 2016; 31:7-10. [PMID: 26304510 DOI: 10.1016/j.arth.2015.07.034] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 06/29/2015] [Accepted: 07/17/2015] [Indexed: 02/01/2023] Open
Abstract
Total joint arthroplasties (TJAs) are projected to increase, along with increased complications like periprosthetic joint infections (PJIs). However, no study has projected TJAs secondary to PJI and how these relate to comorbidities in these patients. The NIS database was assessed from 1993 to 2000 to evaluate primary and revision TJAs, and projections were made until 2028. ICD-9 codes were used to identify patients with obesity, diabetes, and PJI. Rates of diabetes and adult obesity are predicted to increase for both genders, and patients receiving revision surgery for PJI are predicted to increase over time; males had higher rates than females. With an exponential increase of PJI secondary to diabetes and obesity, it is imperative that orthopedists intervene in these patients prior to TJA to decrease PJI's burden.
Collapse
|
20
|
Safety of one-step conversion of gastric band to sleeve: a comparative analysis of ACS-NSQIP data. Surg Obes Relat Dis 2015; 11:386-91. [DOI: 10.1016/j.soard.2014.08.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 08/21/2014] [Accepted: 08/30/2014] [Indexed: 12/25/2022]
|
21
|
Risk Factors for Postoperative Morbidity After Totally Robotic Gastric Bypass in 302 Consecutive Patients. Obes Surg 2014; 25:1229-38. [DOI: 10.1007/s11695-014-1530-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
22
|
Stroh C, Weiner R, Wolff S, Lerche C, Knoll C, Keller T, Bruns C, Manger T. One Versus Two-Step Roux-en-Y Gastric Bypass After Gastric Banding—Data Analysis of the German Bariatric Surgery Registry. Obes Surg 2014; 25:755-62. [DOI: 10.1007/s11695-014-1527-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
23
|
Talbot ML. Revision LAGB to RYGBP in patients with BMI<35: not yet ready for prime time. Surg Obes Relat Dis 2014; 10:1109. [PMID: 25393048 DOI: 10.1016/j.soard.2014.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 10/25/2022]
|
24
|
Emous M, Apers J, Hoff C, van Beek AP, Totté E. Conversion of failed laparoscopic adjustable gastric banding to Roux-en-Y gastric bypass is safe as a single-step procedure. Surg Endosc 2014; 29:2217-23. [PMID: 25318370 DOI: 10.1007/s00464-014-3928-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 09/16/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Several different procedures have been proposed as a revisional procedure for treatment of failed laparoscopic adjustable gastric banding (LAGB). Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been advocated as the procedure of choice for revision. In this study, we compare the single- and two-step approaches for the revision of failed LAGB to LRYGB. METHOD All patients who underwent bariatric surgery were included in a prospective database. For the purpose of this study, patients who underwent revisional surgery from LAGB to LRYGB were selected. Records for individual patients were completed by data review. Complication rates and weight development were recorded until 2 years postoperatively. Data were compared between both procedures and with complications rates reported in literature. RESULTS Revisional gastric bypass surgery was performed in 257 patients. This was done as a planned single-step procedure in 220 (86 %) patients without indications for acute band removal and in 32 patients as a planned 2 step procedure. Five patients were planned as a single-step procedure but were intraoperatively converted to a 2-step procedure based on poor pouch tissue quality. No postoperative mortality occurred in both groups. No differences in early major morbidity and stricture formation were seen between the two groups. Gastric ulceration was more frequently observed after 2-steps procedure (8.5 vs. 1.7 %, p < 0.05). In comparison with data reported in literature, the single-step procedure had similar to lower complication rates. Percentage excess weight loss two years after revisional gastric bypass procedure was, respectively, 53 versus 67 % (p = 0.147) for single- and two-step procedure. CONCLUSION In patients without indications for acute band removal, the planned conversion of gastric banding to Roux-Y gastric bypass can be safely done in a single-step procedure without increase in morbidity and no difference in postoperative weight loss.
Collapse
Affiliation(s)
- M Emous
- Department of Bariatric and Metabolic Surgery, Medisch Centrum Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands,
| | | | | | | | | |
Collapse
|
25
|
Thereaux J, Corigliano N, Poitou C, Oppert JM, Czernichow S, Bouillot JL. Five-year weight loss in primary gastric bypass and revisional gastric bypass for failed adjustable gastric banding: results of a case-matched study. Surg Obes Relat Dis 2014; 11:19-25. [PMID: 25487294 DOI: 10.1016/j.soard.2014.05.033] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/17/2014] [Accepted: 05/12/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND Despite their now frequent use, the long-term results for adjustable gastric bands are variable and often less than gastric bypass. Laparoscopic Roux-en-Y gastric bypass (LRYGB) provides good early results and seems to be the revisional procedure of choice. Nevertheless, the long-term outcomes following revisional LRYGB (rLRYGB) for failed adjustable gastric banding have not been compared with those for primary LRYGB (pLRYGB). METHODS The objective was to compare weight loss and changes in obesity related co-morbidities 5 years after pLRYGB and rLRYGB for failed adjustable gastric banding. The prospective database of a single surgery university center (Paris, France) was queried for clinical and other relevant data. From January 2004 to September 2008, 58 and 272 patients have undergone rLRYGB and pLRYGB, respectively. Rate of lost to follow-up was 13.3%. We matched 45 patients undergoing rLRYGB (case group) with 45 undergoing pLRYGB (control group) for age, sex, and initial body mass index (BMI). RESULTS Case and control groups did not differ for initial BMI (46.9±7.2 versus 46.9±7.5 kg/m²; P=.99), age (43.4±9.4 versus 43.6±9.8y; P=.91), or sex ratio (91.1% female, P=.99). The rates of coexisting conditions in the 2 groups were similar. At 5 years, weight loss (kg) (39.9±16.4 versus 31.4±15.8; P=.02), percentage of weight loss (%) (30.8±9.8 versus 24.8±11.5; P=.03), and percentage of excess weight loss (%) (68.4±20.6 versus 55.7±26.3; P=.007) were higher for pLRYGB than rLRYGB. Rates of remission and improvement of coexisting conditions were similar. CONCLUSION After 5 years of follow-up, pLRYGB provides greater weight loss than rLRYGB with similar rates of improvement and remission of coexisting conditions. Patients and surgeons should be aware of such results before primary and revisional bariatric surgery.
Collapse
Affiliation(s)
- Jérémie Thereaux
- Department of General, Digestive and Metabolic Surgery, Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique- Hôpitaux de Paris, 9, Avenue Charles de Gaulle, 92100 Boulogne, France
| | - Nicola Corigliano
- Department of General, Digestive and Metabolic Surgery, Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique- Hôpitaux de Paris, 9, Avenue Charles de Gaulle, 92100 Boulogne, France
| | - Christine Poitou
- Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique- Hôpitaux de Paris, Pierre-et-Marie-Curie-Paris 6 University, Human Nutrition Research Center Île-de-France (CRNH IdF), Institute of cardiometabolic disease and nutrition (ICAN), 83, boulevard de l'Hôpital, 75013 Paris, France
| | - Jean-Michel Oppert
- Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique- Hôpitaux de Paris, Pierre-et-Marie-Curie-Paris 6 University, Human Nutrition Research Center Île-de-France (CRNH IdF), Institute of cardiometabolic disease and nutrition (ICAN), 83, boulevard de l'Hôpital, 75013 Paris, France
| | - Sebastien Czernichow
- Department of Nutrition, Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique- Hôpitaux de Paris, 9, Avenue Charles de Gaulle, 92100 Boulogne, France; Centre for Research in Epidemiology and Population Health (INSERM U1018), Paul Brousse Hospital, Villejuif, France
| | - Jean-Luc Bouillot
- Department of General, Digestive and Metabolic Surgery, Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique- Hôpitaux de Paris, 9, Avenue Charles de Gaulle, 92100 Boulogne, France.
| |
Collapse
|
26
|
Chantziara K, Laferrère B, Pi-Sunyer X. Bariatric surgery for the treatment of Type 2 diabetes: a step closer? Expert Rev Endocrinol Metab 2014; 9:231-237. [PMID: 30736162 DOI: 10.1586/17446651.2014.894876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Our objective in the present article is to comment on the recently published randomized control trials of bariatric surgery versus medical treatment for managing Type 2 diabetes. In particular, we will discuss how these trials impact the evidence base for the addition of bariatric surgery in Type 2 diabetes treatment algorithms.
Collapse
Affiliation(s)
- Klio Chantziara
- a Endocrinology Practice, 20-22 Pondou street, Athens 11528, Greece
| | - Blandine Laferrère
- b New York Obesity Research Center, St Luke's Roosevelt Hospital, 1111 Amsterdam Avenue, New York, NY 10025, USA
| | - Xavier Pi-Sunyer
- b New York Obesity Research Center, St Luke's Roosevelt Hospital, 1111 Amsterdam Avenue, New York, NY 10025, USA
| |
Collapse
|
27
|
Snider JT, Bognar K, Globe D, Ng-Mak D, Sullivan J, Summers N, Goldman D. Identifying Patients at Risk for High Medical Costs and Good Candidates for Obesity Intervention. Am J Health Promot 2014; 28:218-27. [DOI: 10.4278/ajhp.121116-quan-561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Purpose. To develop a risk-scoring tool to identify in a base year patients likely to have high medical spending in the subsequent year and to understand the role obesity and obesity reduction may play in mitigating this risk. Design. Cross-sectional analysis, using commercial claims and health risk assessment data. Setting. United States, 2004–2009. Subjects. Panel of 192,750 person-year observations from 116,868 unique working-age employees of large companies. Measures. Probability of high medical expenses (80th percentile or above) in the following year; adjusted body mass index (BMI). Analysis. Generate risk scores by modeling the likelihood of high next-year expenses as a function of base-year age, sex, medical utilization, comorbidities, and BMI. Estimate the effect of simulated bariatric intervention on patient risk scores. Results. Individuals with higher BMI were more likely to be categorized in the very high risk group, in which the average annual medical expense was $8621. A weight-loss intervention transitioning a patient to the next lower obesity class was predicted to reduce this risk by 1.5% to 27.4%—comparable to hypothetically curing a patient of depression or type 2 diabetes. Conclusion. A logistic model was used to capture the effect of BMI on the risk of high future medical spending. Weight-loss interventions for obese patients may generate significant savings by reducing this risk.
Collapse
|
28
|
Systematic review on reoperative bariatric surgery: American Society for Metabolic and Bariatric Surgery Revision Task Force. Surg Obes Relat Dis 2014; 10:952-72. [PMID: 24776071 DOI: 10.1016/j.soard.2014.02.014] [Citation(s) in RCA: 234] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 02/09/2014] [Accepted: 02/10/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Reoperative bariatric surgery has become a common practice in many bariatric surgery programs. There is currently little evidence-based guidance regarding specific indications and outcomes for reoperative bariatric surgery. A task force was convened to review the current evidence regarding reoperative bariatric surgery. The aim of the review was to identify procedure-specific indications and outcomes for reoperative procedures. METHODS Literature search was conducted to identify studies reporting indications for and outcomes after reoperative bariatric surgery. Specifically, operations to treat complications, failed weight loss, and weight regain were evaluated. Abstract and manuscript reviews were completed by the task force members to identify, grade, and categorize relevant studies. RESULTS A total of 819 articles were identified in the initial search. After review for inclusion criteria and data quality, 175 articles were included in the systematic review and analysis. The majority of published studies are single center retrospective reviews. The evidence supporting reoperative surgery for acute and chronic complications is described. The evidence regarding reoperative surgery for failed weight loss and weight regain generally demonstrates improved weight loss and co-morbidity reduction after reintervention. Procedure-specific outcomes are described. Complication rates are generally reported to be higher after reoperative surgery compared to primary surgery. CONCLUSION The indications and outcomes for reoperative bariatric surgery are procedure-specific but the current evidence does support additional treatment for persistent obesity, co-morbid disease, and complications.
Collapse
|
29
|
Sheppard CE, Lester ELW, Chuck AW, Birch DW, Karmali S, de Gara CJ. The economic impact of weight regain. Gastroenterol Res Pract 2013; 2013:379564. [PMID: 24454339 PMCID: PMC3888714 DOI: 10.1155/2013/379564] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 11/19/2013] [Indexed: 12/19/2022] Open
Abstract
Background. Obesity is well known for being associated with significant economic repercussions. Bariatric surgery is the only evidence-based solution to this problem as well as a cost-effective method of addressing the concern. Numerous authors have calculated the cost effectiveness and cost savings of bariatric surgery; however, to date the economic impact of weight regain as a component of overall cost has not been addressed. Methods. The literature search was conducted to elucidate the direct costs of obesity and primary bariatric surgery, the rate of weight recidivism and surgical revision, and any costs therein. Results. The quoted cost of obesity in Canada was $2.0 billion-$6.7 billion in 2013 CAD. The median percentage of bariatric procedures that fail due to weight gain or insufficient weight loss is 20% (average: 21.1% ± 10.1%, range: 5.2-39, n = 10). Revision of primary surgeries on average ranges from 2.5% to 18.4%, and depending on the procedure accounts for an additional cost between $14,000 and $50,000 USD per patient. Discussion. There was a significant deficit of the literature pertaining to the cost of revision surgery as compared with primary bariatric surgery. As such, the cycle of weight recidivism and bariatric revisions has not as of yet been introduced into any previous cost analysis of bariatric surgery.
Collapse
Affiliation(s)
- Caroline E. Sheppard
- Centre for the Advancement of Minimally Invasive Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada T5H 3V9
| | | | - Anderson W. Chuck
- University of Alberta, Institute of Health Economics, Edmonton, AB, Canada T5J 3N4
| | - Daniel W. Birch
- Centre for the Advancement of Minimally Invasive Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada T5H 3V9
| | - Shahzeer Karmali
- Centre for the Advancement of Minimally Invasive Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada T5H 3V9
| | - Christopher J. de Gara
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, 2-590 Edmonton Clinic Health Academy, 11405-87 Avenue NW, Edmonton, AB, Canada T6G 2C9
| |
Collapse
|
30
|
Laparoscopic reversal of Roux-en-Y gastric bypass into normal anatomy with or without sleeve gastrectomy. Surg Endosc 2013; 27:4640-8. [DOI: 10.1007/s00464-013-3087-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 06/24/2013] [Indexed: 01/20/2023]
|
31
|
Hartendorp P, Telem DA. Is the Band a Good Procedure Choice, and for Whom Should We Still Consider It? CURRENT SURGERY REPORTS 2013. [DOI: 10.1007/s40137-013-0025-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|