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Revisional Bariatric Surgery due to Complications: Indications and Outcomes

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Abstract

Background

The increasing prevalence of bariatric procedures has led to a surge in revisional surgeries. Failure of bariatric surgery can be attributed to inadequate weight loss or complications necessitating revisional surgery. In this study, we investigated the indications and outcomes of revisional surgery due to complications following primary bariatric surgery.

Materials and Methods

A retrospective study was conducted using data from the Tehran Obesity Treatment Study, which included patients who underwent revisional bariatric surgery between March 2013 and September 2021 due to complications following primary bariatric surgery.

Results

Of the 5382 patients who underwent primary bariatric surgery (sleeve gastrectomy, one-anastomosis gastric bypass, and Roux-en-Y gastric bypass), 203 (3.70%) required revisional surgery, with 37 cases performed due to surgical complications. The indications of revisional operations were gastroesophageal reflux disease (GERD) (n=17, 45.9%), protein-calorie malnutrition (PCM) (n=14, 37.8%), unexplained abdominal pain (n=5, 13.5%), and phytobezoar (n=1, 0.03%). In the postoperative follow-up, most patients exhibited improvement in signs and symptoms related to underlying causes. However, eight patients experienced early or late complications of grade III or higher according to the Clavien-Dindo classification, with one death resulting from liver failure.

Conclusion

Revisional bariatric surgery may effectively address complications from primary bariatric surgery, with the majority of patients experiencing improvements in symptoms. While the overall incidence of revisional surgery due to complications is relatively low, our findings suggest that GERD and PCM are the most common indications for revisional surgery.

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Data Availability

The datasets used and analyzed in the current study are available from the corresponding author on reasonable request.

References

  1. Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014;2014(8):Cd003641.

    PubMed  PubMed Central  Google Scholar 

  2. English WJ, DeMaria EJ, Hutter MM, et al. American Society for Metabolic and Bariatric Surgery 2018 estimate of metabolic and bariatric procedures performed in the United States. Surg Obes Relat Dis : Off J Am Soc Bariatric Surg. 2020;16(4):457–63.

    Article  Google Scholar 

  3. Clapp B, Harper B, Dodoo C, Klingsporn W, Barrientes A, Cutshall M, Tyroch A. Trends in revisional bariatric surgery using the MBSAQIP database 2015–2017. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2020;16(7):908–15.

    Article  PubMed  Google Scholar 

  4. Brethauer SA, Kothari S, Sudan R, et al. Systematic review on reoperative bariatric surgery: American Society for Metabolic and Bariatric Surgery Revision Task Force. Surg Obes Relat Dis : Off J Am Soc Bariatric Surg. 2014;10(5):952–72.

    Article  Google Scholar 

  5. Inabnet 3rd WB, Belle SH, Bessler M, et al. Comparison of 30-day outcomes after non-LapBand primary and revisional bariatric surgical procedures from the longitudinal assessment of bariatric surgery study. Surg Obes Relat Dis : Off J Am Soc Bariatric Surg. 2010;6(1):22–30.

    Article  Google Scholar 

  6. Vanetta C, Dreifuss NH, Schlottmann F, et al. Bariatric surgery conversions in MBSAQIP centers: current indications and outcomes. Obes. Surg. 2022;32(10):3248–56.

    Article  PubMed  Google Scholar 

  7. Barzin M, Hosseinpanah F, Motamedi MA, et al. Bariatric surgery for morbid obesity: Tehran Obesity Treatment Study (TOTS) rationale and study design. JMIR Res Protoc. 2016;5(1):e8.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Shaw MJ, Talley NJ, Beebe TJ, et al. Initial validation of a diagnostic questionnaire for gastroesophageal reflux disease. Am J Gastroenterol. 2001;96(1):52–7.

    Article  CAS  PubMed  Google Scholar 

  9. Blackburn GL, Bistrian BR, Maini BS, et al. Nutritional and metabolic assessment of the hospitalized patient. JPEN J Parenter Enteral Nutr. 1977;1(1):11–22.

    Article  CAS  PubMed  Google Scholar 

  10. Chisholm EM, Leong HT, Chung SC, et al. Phytobezoar: an uncommon cause of small bowel obstruction. Ann R Coll Surg Engl. 1992;74(5):342–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Iwamuro M, Okada H, Matsueda K, et al. Review of the diagnosis and management of gastrointestinal bezoars. World J Gastrointest Endosc. 2015;7(4):336–45.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Alsulaimy M, Punchai S, Ali FA, et al. The utility of diagnostic laparoscopy in post-bariatric surgery patients with chronic abdominal pain of unknown etiology. Obes Surg. 2017;27(8):1924–8.

    Article  PubMed  Google Scholar 

  13. Ebrahimi M, Ebrahimi R, Khlaj A, et al. Severe fatal protein malnutrition and liver failure in a morbidly obese patient after mini-gastric bypass surgery: case report. Int J Surg Case Rep. 2019;33.

  14. Kelly T, Yang W, Chen CS, et al. Global burden of obesity in 2005 and projections to 2030. Int J Obes. 2005;32(9):1431–7.

    Article  Google Scholar 

  15. Merrouche M, Sabaté JM, Jouet P, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery. Obes Surg. 2007;17(7):894–900.

    Article  PubMed  Google Scholar 

  16. Sharara AI, Rustom LBO, Bou Daher H, et al. Prevalence of gastroesophageal reflux and risk factors for erosive esophagitis in obese patients considered for bariatric surgery. Dig Liver Dis : Off J Italian Soc Gastroenterol Italian Assoc Study Liver. 2019;51(10):1375–9.

    Article  Google Scholar 

  17. Peterli R, Wölnerhanssen BK, Peters T, et al. Effect of Laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. Jama. 2018;319(3):255–65.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Genco A, Castagneto-Gissey L, Gualtieri L, et al. GORD and Barrett’s oesophagus after bariatric procedures: multicentre prospective study. Br J Surg. 2021;108(12):1498–505.

    Article  PubMed  Google Scholar 

  19. Matar R, Monzer N, Jaruvongvanich V, et al. Indications and outcomes of conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: a systematic review and a meta-analysis. Obes Surg. 2021;31(9):3936–46.

    Article  PubMed  Google Scholar 

  20. Chiappetta S, Lainas P, Kassir R, et al. Gastroesophageal reflux disease as an indication of revisional bariatric surgery-indication and results-a systematic review and metanalysis. Obes Surg. 2022;32(9):3156–71.

    Article  PubMed  Google Scholar 

  21. El-Serag HB, Sweet S, Winchester CC, et al. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014;63(6):871–80.

    Article  PubMed  Google Scholar 

  22. Mion F, Tolone S, Garros A, et al. High-resolution impedance manometry after sleeve gastrectomy: increased intragastric pressure and reflux are frequent events. Obes Surg. 2016;26(10):2449–56.

    Article  PubMed  Google Scholar 

  23. Del Genio G, Tolone S, Limongelli P, et al. Sleeve gastrectomy and development of “de novo” gastroesophageal reflux. Obes Surg. 2014;24(1):71–7.

    Article  PubMed  Google Scholar 

  24. Klaus A, Weiss H. Is preoperative manometry in restrictive bariatric procedures necessary? Obes Surg. 2008;18(8):1039–42.

    Article  PubMed  Google Scholar 

  25. Hayat JO, Wan A. The effects of sleeve gastectomy on gastro-esophageal reflux and gastro-esophageal motility. Expert Rev Gastroenterol Hepatol. 2014;8(4):445–52.

    Article  CAS  PubMed  Google Scholar 

  26. Rebecchi F, Ugliono E, Morino M. Reflux following bariatric surgery. Mini-invasive. Surgery. 2022;6:30.

    Google Scholar 

  27. Malinowski SS. Nutritional and metabolic complications of bariatric surgery. Am J Med Sci. 2006;331(4):219–25.

    Article  PubMed  Google Scholar 

  28. Faintuch J, Matsuda M, Cruz ME, et al. Severe protein-calorie malnutrition after bariatric procedures. Obes Surg. 2004;14(2):175–81.

    Article  PubMed  Google Scholar 

  29. Marceau P, Hould FS, Lebel S, et al. Malabsorptive obesity surgery. Surg Clin North Am. 2001;81(5):1113–27.

    Article  CAS  PubMed  Google Scholar 

  30. Stocker DJ. Management of the bariatric surgery patient. Endocrinol Metab Clin N Am. 2003;32(2):437–57.

    Article  Google Scholar 

  31. Khrucharoen U, Juo YY, Chen Y, et al. Indications, operative techniques, and outcomes for revisional operation following mini-gastric bypass-one anastomosis gastric bypass: a systematic review. Obes Surg. 2020;30(4):1564–73.

    Article  PubMed  Google Scholar 

  32. Khalaj A, Kalantar Motamedi MA, Mousapour P, et al. Protein-calorie malnutrition requiring revisional surgery after one-anastomosis-mini-gastric bypass (OAGB-MGB): case series from the Tehran Obesity Treatment Study (TOTS). Obes Surg. 2019;29(6):1714–20.

    Article  PubMed  Google Scholar 

  33. Cain GD, Moore P, Patterson M. Bezoars—a complication of the postgastrectomy state. Am J Dig Dis. 1968;13(9):801–9.

    Article  Google Scholar 

  34. Pinto D, Carrodeguas L, Soto F, et al. Gastric bezoar after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2006;16(3):365–8.

    Article  PubMed  Google Scholar 

  35. Ben-Porat T, Sherf Dagan S, Goldenshluger A, et al. Gastrointestinal phytobezoar following bariatric surgery: systematic review. Surg Obes Relat Dis : Off J Am Soc Bariatric Surg. 2016;12(9):1747–54.

    Article  Google Scholar 

  36. Aryannezhad S, Sadeghian Y, Shapoori P, et al. A rare case report of late-onset phytobezoar formation following laparoscopic sleeve gastrectomy: delayed redo bariatric surgery. BMC Surg. 2021;21(1):254.

    Article  PubMed  PubMed Central  Google Scholar 

  37. da Cruz MRR, Branco-Filho AJ, Zaparolli MR, et al. Predictors of success in bariatric surgery: the role of BMI and pre-operative comorbidities. Obes Surg. 2018;28(5):1335–41.

    Article  PubMed  Google Scholar 

  38. Jansen CMAH, Bonouvrie DS, Jacobs MLYE, et al. Chronic abdominal pain after previous bariatric surgery: consider the abdominal wall. Obes Surg. 2020;30(8):2942–8.

    Article  PubMed  Google Scholar 

  39. Pierik AS, Coblijn UK, de Raaff CAL, et al. Unexplained abdominal pain in morbidly obese patients after bariatric surgery. Surg Obes Relat Dis : Off J Am Soc Bariatric Surg. 2017;13(10):1743–51.

    Article  Google Scholar 

  40. de Zwaan M, Hilbert A, Swan-Kremeier L, et al. Comprehensive interview assessment of eating behavior 18-35 months after gastric bypass surgery for morbid obesity. Surg Obes Relat Dis : Off J Am Soc Bariatric Surg. 2010;6(1):79–85.

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank the hospital staff, assistants, and coordinators who took part in this research. Also, special thanks to Mohammadreza Golsibi for his assistance and support of the electronic data collection system. This article was derived from the disease registry entitled “Registration of patients in Tehran Obesity Treatment Center” and approved under the ethical code of “IR.SBMU.ENDOCRINE.REC1397.059” (date: 2018-05-08) by the local ethics committee.

Funding

The study was supported by the Deputy of Research and Technology of Shahid Beheshti University of Medical Sciences (http://dregistrysbmu.ac.ir).

Author information

Author notes

  1. Alireza Khalaj and Maryam Barzin equally contributed to the first authorship.

  2. Amir Ebadinejad and Farhad Hosseinpanah equally contributed to the correspondence authorship.

Authors and Affiliations

  1. Tehran Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran

    Alireza Khalaj

  2. Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-476, Tehran, Iran

    Maryam Barzin, Amir Ebadinejad, Maryam Mahdavi, Navid Ebrahimi, Majid Valizadeh & Farhad Hosseinpanah

Authors
  1. Alireza Khalaj
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Contributions

AK: study design, performing surgical operations, and the final approval of the manuscript. MB: study design, data collection, the coordination of patients’ issues and manuscript preparation, and the final approval of the manuscript. AE: study design, the coordination of patients’ issues and manuscript preparation, and the final approval of the manuscript. NE: data collection, literature review, and manuscript preparation. MM: data analysis, interpretation, and manuscript preparation. MV: final approval of the manuscript. FH: study design, revising, and the final approval of the manuscript. All authors reviewed and approved the final draft of the manuscript.

Corresponding authors

Correspondence to Amir Ebadinejad or Farhad Hosseinpanah.

Ethics declarations

Ethical Approval and Consent to Participate

All the procedures performed in the study were approved by Research Ethics Committee of the Research Institute for Endocrine Sciences of Shahid Beheshti University of Medical Sciences and were in accordance with the ethical standards of the institutional Human Research Review Committee (No. 2ECRIES 93/03/13) and the 1964 Helsinki declaration and its later amendments. Informed written consent was obtained from all individual participants included in the study.

Consent for Publication

Not applicable.

Conflict of Interest

The authors declare no competing interests.

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Key Points

• The incidence of revisional surgery due to complications following primary bariatric surgery was 0.6%.

• The most frequent indications for revisional surgery were GERD following SG and PCM following OAGB.

• The median time interval between primary surgery and revisional surgery was 12 months for PCM and 42 months for GERD.

• While most patients who underwent revisional surgery for PCM showed improvements in clinical and laboratory signs, one patient died due to liver failure.

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Khalaj, A., Barzin, M., Ebadinejad, A. et al. Revisional Bariatric Surgery due to Complications: Indications and Outcomes. OBES SURG 33, 3463–3471 (2023). https://doi.org/10.1007/s11695-023-06832-8

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