Background

Revision of bariatric procedures is the third most common bariatric surgery performed in the United States, with studies showing limited additional weight loss. This study aimed to identify patients who underwent surgical revision and assess for resolution of preoperative symptoms, improvement of obesity-related comorbidities, and weight loss over time compared to patients who receive primary roux-en-y gastric bypass (RYGB) or vertical sleeve gastrectomy (VSG).

Methods

A single-institution prospectively managed database of patients who underwent bariatric surgery from 2018 to 2021 was analyzed, identifying patients who had a laparoscopic adjustable gastric band (LAGB), vertical banded gastroplasty (VBG), or VSG revised to either RYGB or VSG. The primary outcome was resolution of pre-operative adverse symptoms. Secondary outcomes included improvement of obesity-related comorbidities including gastroesophageal reflux disease (GERD), hypertension (HTN), and diabetes (DM), and noninferior change in post-operative body mass index (BMI) compared to primary RYGB or VSG.

Results

333 total patients were included: LAGB to RYGB (14), LAGB to VSG (10), VBG to RYGB (9), VSG to RYGB (19), primary RYGB (97), primary VSG (175). 78.8% patients had adverse preoperative symptoms while 9.6% had post-operative symptoms. Patients with comorbidities requiring medications improved: HTN (57.7%-36.5%), DM (25%-13.5%), GERD (63.5%-57.7%). By 12 months, the average decrease in BMI between revision (14.0+-7.1) and primary surgeries (16.2+-5.5) was found to be noninferior (p=0.2).

Conclusions

Revision bariatric surgery can have similar outcomes in terms of weight loss and improvement of obesity-related comorbidities while improving or resolving pre-operative adverse symptoms necessitating the revision.