Background

Revisional bariatric surgery is gaining popularity yearly. Rates of revisional procedures grow but indications are not always clear. Third or even fourth procedures are less known and reported.

Methods

Retrospective review of multioperated bariatric patients (2 or more) from 3 tertiary referral centers. We analyzed indications for the procedures and their results.

Results

All 3 centers included more than 2000 procedures each for the last 20 years. There were 423 second, 28 third and 3 fourth procedures, representing 9.03%, 0.6% and 0.09% of the whole bariatric procedures. Most of the second procedures were conversions (339 out of 423), mainly from Sleeve Gastrectomy (313 cases). Main indications were insufficient weight loss and reflux. Third and fourth procedures were mainly to treat sequelae or side effects from previous procedures. Third revisional procedures were mainly conversions to deal with complications (18 out of 28) and all 3 fourth revisions were reversals to normal anatomy. Morbidity was slightly higher from primary procedures. No mortality was found in those revisional procedures. Most common final procedure was RYGB (190 cases) and in 56 normal anatomy was reconstructed.

Conclusions

Weight loss issues are not always the main indication, mainly in third and fourth surgeries. After second surgeries, metabolic side effects are the main indication. Distribution of conversion, modifications and reversals vary from the number of procedures. Morbidity is slightly higher than primary cases in referral centers.