Background

Malnutrition after bariatric surgery is a rare yet potentially life-threatening complication. The safety and efficacy of revisional surgery in malnourished patients are poorly described.

Methods

We performed a retrospective chart review of patients who underwent revisional bariatric surgery for severe malnutrition at our institute between 2008 and 2020. Data were analyzed for the latest follow-up postoperatively. Associations of demographic and clinical characteristics with dichotomous outcomes of interest were carried out using Fisher exact tests, Cochran-Armitage tests for trend, and two-sample t-tests when appropriate.

Results

53 patients were included with median follow-up of 24 months. The anatomy before revision was 8% restrictive and 93% bypass anatomy. Bariatric and abdominal operations before our revision had a median of 2 (range 1-7) and 3 (range 1-9), respectively. Thirty-seven (70%) operations were performed via open approach, while 2 of the 16 laparoscopic operations required conversion to open (Table 1). The percentage of patients requiring supplemental or total nutritional support decreased from 89% preoperatively (47% on enteral feedings, and 42% on TPN+-tube feedings) to 14% at the last encounter after revision (8% still requiring enteral feedings and 6% on TPN). Early and late complications are detailed in Table 2. Two patients died during our median follow-up of 24 months, all occurred >1 year postoperatively. No correlation existed between discontinuation of supportive nutrition, or Clavien-Dindo major complications, and any preoperative variable.

Conclusions

Revisional surgery for severely malnourished bariatric surgery patients is effective in the discontinuation of supportive nutrition. Postoperative complications are increased but not prohibitive.