A two-decade spectrum of revisional bariatric surgery at a tertiary referral center

Elizabeth M. Nesset, Michael L. Kendrick, Scott G. Houghton, Jane L. Mai, Geoffrey B. Thompson, Florencia Que, Kristine M. Thomsen, Dirk R. Larson, Michael G. Sarr

Research output: Contribution to journalArticle

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Abstract

Background: Ineffective weight loss or complications of previous bariatric surgery often require revisional bariatric procedures. Our aim was to define the indications, operative approach, and outcomes of revisional bariatric procedures during 2 decades at a tertiary center. Methods: From our prospective database (n = 1584), including 1985-2004, 218 patients (14%) underwent revisional bariatric procedures. Follow-up (mean 7 yr, range 1 mo to 19 yr) data obtained from patient records and questionnaires were current for 98%. Patients were grouped according to operative indications: group 1, unsatisfactory weight loss (n = 97); group 2, mechanical/symptomatic complications (n = 95); and group 3, severe nutritional/metabolic problems (n = 26). Results: The operative mortality rate was 0.9% (1 case each of pulmonary embolus and cardiac arrest). The serious operative morbidity rate was 26% (wound infection in 13%, leak in 3%, pulmonary embolus in 2%, anemia/hemorrhage in 2%, pneumonia/prolonged ventilation in 2%, and other in 4%). Of the 218 patients, 94% underwent conversion to, or revision of, Roux-en-y gastric bypass. Group 1 achieved substantial weight reduction with a mean body mass index from 51 ± 1 to 38 ± 1 kg/m2, the complications resolved in 88% of group 2, and the nutritional/metabolic problems resolved in 79% of group 3. Patients who underwent revisional surgery 1990 were more likely to present with mechanical/symptomatic/metabolic complications than for unsuccessful weight loss (P <.001). Conclusions: Revisional bariatric surgery is safe and effective in experienced centers. Complications (mechanical/symptomatic/nutritional) or unsatisfactory weight loss after primary bariatric procedures can be treated effectively with revision to Roux-en-y gastric bypass.

Original languageEnglish (US)
Pages (from-to)25-30
Number of pages6
JournalSurgery for Obesity and Related Diseases
Volume3
Issue number1
DOIs
StatePublished - Jan 2007

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Bariatric Surgery
Bariatrics
Tertiary Care Centers
Weight Loss
Gastric Bypass
Embolism
Lung
Wound Infection
Heart Arrest
Ventilation
Anemia
Pneumonia
Body Mass Index
Databases
Hemorrhage
Morbidity
Mortality

Keywords

  • Medically complicated obesity
  • Revisional bariatric surgery
  • Roux-en-y gastric bypass

ASJC Scopus subject areas

  • Surgery

Cite this

Nesset, E. M., Kendrick, M. L., Houghton, S. G., Mai, J. L., Thompson, G. B., Que, F., ... Sarr, M. G. (2007). A two-decade spectrum of revisional bariatric surgery at a tertiary referral center. Surgery for Obesity and Related Diseases, 3(1), 25-30. https://doi.org/10.1016/j.soard.2006.10.010

A two-decade spectrum of revisional bariatric surgery at a tertiary referral center. / Nesset, Elizabeth M.; Kendrick, Michael L.; Houghton, Scott G.; Mai, Jane L.; Thompson, Geoffrey B.; Que, Florencia; Thomsen, Kristine M.; Larson, Dirk R.; Sarr, Michael G.

In: Surgery for Obesity and Related Diseases, Vol. 3, No. 1, 01.2007, p. 25-30.

Research output: Contribution to journalArticle

Nesset, EM, Kendrick, ML, Houghton, SG, Mai, JL, Thompson, GB, Que, F, Thomsen, KM, Larson, DR & Sarr, MG 2007, 'A two-decade spectrum of revisional bariatric surgery at a tertiary referral center', Surgery for Obesity and Related Diseases, vol. 3, no. 1, pp. 25-30. https://doi.org/10.1016/j.soard.2006.10.010
Nesset, Elizabeth M. ; Kendrick, Michael L. ; Houghton, Scott G. ; Mai, Jane L. ; Thompson, Geoffrey B. ; Que, Florencia ; Thomsen, Kristine M. ; Larson, Dirk R. ; Sarr, Michael G. / A two-decade spectrum of revisional bariatric surgery at a tertiary referral center. In: Surgery for Obesity and Related Diseases. 2007 ; Vol. 3, No. 1. pp. 25-30.
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abstract = "Background: Ineffective weight loss or complications of previous bariatric surgery often require revisional bariatric procedures. Our aim was to define the indications, operative approach, and outcomes of revisional bariatric procedures during 2 decades at a tertiary center. Methods: From our prospective database (n = 1584), including 1985-2004, 218 patients (14{\%}) underwent revisional bariatric procedures. Follow-up (mean 7 yr, range 1 mo to 19 yr) data obtained from patient records and questionnaires were current for 98{\%}. Patients were grouped according to operative indications: group 1, unsatisfactory weight loss (n = 97); group 2, mechanical/symptomatic complications (n = 95); and group 3, severe nutritional/metabolic problems (n = 26). Results: The operative mortality rate was 0.9{\%} (1 case each of pulmonary embolus and cardiac arrest). The serious operative morbidity rate was 26{\%} (wound infection in 13{\%}, leak in 3{\%}, pulmonary embolus in 2{\%}, anemia/hemorrhage in 2{\%}, pneumonia/prolonged ventilation in 2{\%}, and other in 4{\%}). Of the 218 patients, 94{\%} underwent conversion to, or revision of, Roux-en-y gastric bypass. Group 1 achieved substantial weight reduction with a mean body mass index from 51 ± 1 to 38 ± 1 kg/m2, the complications resolved in 88{\%} of group 2, and the nutritional/metabolic problems resolved in 79{\%} of group 3. Patients who underwent revisional surgery 1990 were more likely to present with mechanical/symptomatic/metabolic complications than for unsuccessful weight loss (P <.001). Conclusions: Revisional bariatric surgery is safe and effective in experienced centers. Complications (mechanical/symptomatic/nutritional) or unsatisfactory weight loss after primary bariatric procedures can be treated effectively with revision to Roux-en-y gastric bypass.",
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AU - Que, Florencia

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N2 - Background: Ineffective weight loss or complications of previous bariatric surgery often require revisional bariatric procedures. Our aim was to define the indications, operative approach, and outcomes of revisional bariatric procedures during 2 decades at a tertiary center. Methods: From our prospective database (n = 1584), including 1985-2004, 218 patients (14%) underwent revisional bariatric procedures. Follow-up (mean 7 yr, range 1 mo to 19 yr) data obtained from patient records and questionnaires were current for 98%. Patients were grouped according to operative indications: group 1, unsatisfactory weight loss (n = 97); group 2, mechanical/symptomatic complications (n = 95); and group 3, severe nutritional/metabolic problems (n = 26). Results: The operative mortality rate was 0.9% (1 case each of pulmonary embolus and cardiac arrest). The serious operative morbidity rate was 26% (wound infection in 13%, leak in 3%, pulmonary embolus in 2%, anemia/hemorrhage in 2%, pneumonia/prolonged ventilation in 2%, and other in 4%). Of the 218 patients, 94% underwent conversion to, or revision of, Roux-en-y gastric bypass. Group 1 achieved substantial weight reduction with a mean body mass index from 51 ± 1 to 38 ± 1 kg/m2, the complications resolved in 88% of group 2, and the nutritional/metabolic problems resolved in 79% of group 3. Patients who underwent revisional surgery 1990 were more likely to present with mechanical/symptomatic/metabolic complications than for unsuccessful weight loss (P <.001). Conclusions: Revisional bariatric surgery is safe and effective in experienced centers. Complications (mechanical/symptomatic/nutritional) or unsatisfactory weight loss after primary bariatric procedures can be treated effectively with revision to Roux-en-y gastric bypass.

AB - Background: Ineffective weight loss or complications of previous bariatric surgery often require revisional bariatric procedures. Our aim was to define the indications, operative approach, and outcomes of revisional bariatric procedures during 2 decades at a tertiary center. Methods: From our prospective database (n = 1584), including 1985-2004, 218 patients (14%) underwent revisional bariatric procedures. Follow-up (mean 7 yr, range 1 mo to 19 yr) data obtained from patient records and questionnaires were current for 98%. Patients were grouped according to operative indications: group 1, unsatisfactory weight loss (n = 97); group 2, mechanical/symptomatic complications (n = 95); and group 3, severe nutritional/metabolic problems (n = 26). Results: The operative mortality rate was 0.9% (1 case each of pulmonary embolus and cardiac arrest). The serious operative morbidity rate was 26% (wound infection in 13%, leak in 3%, pulmonary embolus in 2%, anemia/hemorrhage in 2%, pneumonia/prolonged ventilation in 2%, and other in 4%). Of the 218 patients, 94% underwent conversion to, or revision of, Roux-en-y gastric bypass. Group 1 achieved substantial weight reduction with a mean body mass index from 51 ± 1 to 38 ± 1 kg/m2, the complications resolved in 88% of group 2, and the nutritional/metabolic problems resolved in 79% of group 3. Patients who underwent revisional surgery 1990 were more likely to present with mechanical/symptomatic/metabolic complications than for unsuccessful weight loss (P <.001). Conclusions: Revisional bariatric surgery is safe and effective in experienced centers. Complications (mechanical/symptomatic/nutritional) or unsatisfactory weight loss after primary bariatric procedures can be treated effectively with revision to Roux-en-y gastric bypass.

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