Revisional bariatric surgery - Safe and effective

Background: Revision operations have traditionally been considered difficul t and associated with a high complication and long-term failure rate. This paper demonstrates that revision and/or conversions to Roux-en-Y gastric by pass are generally safe as well as effective in long-term weight maintenanc e and control of co-morbidities, Methods: A retrospective study from January 1989 through August 1999 was do ne involving 141 patients who had had various gastroplasty (118), gastric b anding (6), jejunoileal bypass (3), or loop (2) and Roux-en-Y gastric bypas s (RYGBP) procedures (12), with either technical failures or poor long-term maintained weight loss. Results: The demographics were: mean pre-operative weight at original surge ry 264 Ibs (120 kg); postop weight at a mean elapsed time since surgery of 5 years, 4 months: 188 Ibs (85 kg), or a mean excess weight loss of 59%, Th e mean BMI dropped from a pre-op 45 to a post-op 31. There were 7 complicat ions which required emergency surgery (5%), which included 4 leaks, 2 subph renic abscesses, and 1 wound dehiscence, Other complications included 4 her nias, 3 staple-line failures, 1 transient renal failure, and 3 incidences o f peptic ulcer disease requiring surgery, giving a total major complication rate of 13% in 17 patients, with no deaths. An earlier experience of this author comparing conversion RYGBP vs revision gastroplasty found better mor bidity rates and weight loss with those converted to RYGBP, Conclusion: Converting failed gastric limiting and other bariatric procedur es to RYGBP was safe and effective. Technical approaches to each problem ty pe encountered are presented.