Study Finds Higher Risk of Complications After Bariatric Surgery Revisions
The number of bariatric surgery procedures in the United States has doubled in the last six years, according to data from the American Society for Metabolic and Bariatric Surgery. Although it is considered the most effective approach for long-term weight management, some patients must undergo a revision to their procedure due to inadequate weight loss or other complications that may arise.
A new study in the February issue of JAMA’s Archives of Surgery has found that revisional bariatric surgery occurs in anywhere from 5 to 56% of post-surgical patients and is associated with a higher risk of complications than the original procedure.
Dr. Charalambos Spyropoulas MD and colleagues from the Unversity Hospital of Patras, Rion in Greece studied 56 patients who underwent revisional bariatric surgery between 1995 and 2008. Of those, 39 were undergoing the second procedure due to unsatisfactory weight loss, 15 had severe nutritional complications, and 2 had adverse effects from the initial procedure that included blocking or narrowing of the stoma leading into the intestine (called stomal obstruction or stomal stenosis).
Historically, revisional bariatric surgery has been considered high-risk with an overall complication rate that approached 50% with a mortality (death) rate that was as high as 5 to 10% in some published reports. However, during the past ten years, the results have improved because of the increased experience of surgeons performing the operations and advances in surgical techniques, including the ability to do the surgery laparoscopically.
The participants were followed for an average of 102 months after the revisional surgery. There were no mortalities, but 19 of the patients, or almost 34%, had serious complications within 30 to 90 days, including internal leakage from the gastrojejunal anastomosis, acute kidney failure, and pneumonia. Late complications (defined as being more than 90 days after the procedure) occurred in 13 of the patients. These included incisional hernia, narrowing of the anastomosis, and low levels of albumin indicating protein malnutrition.
Although the complications did occur, most patients ended up with overall positive outcomes after revisional surgery. Those who previously had inadequate weight loss experienced a significant drop in BMI. Those with nutritional complications say signs and symptoms completely resolved.
Those involved in the study had either a biliopancreatic diversion or Roux-en-Y gastric bypass procedure. In the United States, the gastric bypass is the most common bariatric surgery procedure performed and has approximately a 5-10% revision rate. This particular study did not include another common weight-loss operation called the Adjustable Gastric Band, which also has at least a 10% revision rate in the first two years after surgery due to device related problems or unsatisfactory weight loss.
Revisional surgery options are varied based upon the type of surgery originally performed. For those having gastric bypass, for example, the placement of an adjustable band around an enlarged stomach pouch can reduce the amount of food that can be eaten. A new non-surgical approach that is being performed in the United States for people with narrowed stomas include a procedure called Stomaphyx that dilates the anastomosis using an endoscopic tube.
Revisional Bariatric Surgery: 13-Year Experience From a Tertiary Institution Charalambos Spyropoulos, MD; Ioannis Kehagias, MD; Spyros Panagiotopoulos, MD; Nancy Mead, MS; Fotis Kalfarentzos, MD Arch Surg. 2010;145(2):173-177.