Reoperative bariatric surgery

Lessons learned to improve patient selection and results

K. E. Behrns, C. D. Smith, K. A. Kelly, M. G. Sarr

Research output: Contribution to journalArticle

132 Citations (Scopus)

Abstract

Objective. The purpose of this study was to determine the spectrum of presentation, safety, and efficacy of operative bariatric surgery. Summary Background Data. The only lasting therapy for medically complicated clinically severe obesity is bariatric surgery. Several operative approaches have resulted in disappointing long-term weight loss or an unacceptable incidence of complications that require revisionary surgery. Methods. Sixty- one consecutive patients who underwent reoperative bariatric surgery from 1985 to 1990 were observed prospectively. One, two, or three previous bariatric procedures had been performed in 77%, 18%, and 5% of patients, respectively. Reoperation was required for unsatisfactory weight loss after gastroplasty or gastric bypass (61%), metabolic complications of jejunoileal bypass (23%), or other complications (16%), including stomal obstruction, alkaline- or acid-reflux esophagitis, and anastomotic ulcer. Revisionary procedures included conversion to vertical banded gastroplasty (33% of operations) and vertical Roux-en-Y gastric bypass (52% of operations); partial pancreato-biliary bypass was used selectively in four patients with severe, medically complicated obesity. Results. A single patient died postoperatively of a pulmonary embolus; serious morbidity occurred in 11%. Weight loss (̄X ± SEM) after reoperation for unsuccessful weight loss was greater with gastric bypass than with vertical banded gastroplasty (54 ± 6% versus 24 ± 6% of excess body weight). Metabolic complications of jejunoileal bypass were corrected, but 67% of the patients were dissatisfied with their postoperative lifestyle because of changes in eating habits or weight gain (64% of patients). Stomal complications and esophageal reflux symptoms were reversed in all patients. Conclusions. Reoperative bariatric surgery in selected patients is safe and effective for unsatisfactory weight loss or for complications of previous bariatric procedures. Conversion to gastric bypass provides more effective weight loss than vertical banded gastroplasty.

Original languageEnglish (US)
Pages (from-to)646-653
Number of pages8
JournalAnnals of Surgery
Volume218
Issue number5
StatePublished - 1993

Fingerprint

Bariatric Surgery
Patient Selection
Gastroplasty
Weight Loss
Gastric Bypass
Jejunoileal Bypass
Bariatrics
Reoperation
Peptic Esophagitis
Morbid Obesity
Feeding Behavior
Gastroesophageal Reflux
Embolism
Ulcer
Weight Gain
Life Style
Obesity
Body Weight
Morbidity
Safety

ASJC Scopus subject areas

  • Surgery

Cite this

Behrns, K. E., Smith, C. D., Kelly, K. A., & Sarr, M. G. (1993). Reoperative bariatric surgery: Lessons learned to improve patient selection and results. Annals of Surgery, 218(5), 646-653.

Reoperative bariatric surgery : Lessons learned to improve patient selection and results. / Behrns, K. E.; Smith, C. D.; Kelly, K. A.; Sarr, M. G.

In: Annals of Surgery, Vol. 218, No. 5, 1993, p. 646-653.

Research output: Contribution to journalArticle

Behrns, KE, Smith, CD, Kelly, KA & Sarr, MG 1993, 'Reoperative bariatric surgery: Lessons learned to improve patient selection and results', Annals of Surgery, vol. 218, no. 5, pp. 646-653.
Behrns, K. E. ; Smith, C. D. ; Kelly, K. A. ; Sarr, M. G. / Reoperative bariatric surgery : Lessons learned to improve patient selection and results. In: Annals of Surgery. 1993 ; Vol. 218, No. 5. pp. 646-653.
@article{40b0bb0d385b469ea7bcc92eaf80570d,
title = "Reoperative bariatric surgery: Lessons learned to improve patient selection and results",
abstract = "Objective. The purpose of this study was to determine the spectrum of presentation, safety, and efficacy of operative bariatric surgery. Summary Background Data. The only lasting therapy for medically complicated clinically severe obesity is bariatric surgery. Several operative approaches have resulted in disappointing long-term weight loss or an unacceptable incidence of complications that require revisionary surgery. Methods. Sixty- one consecutive patients who underwent reoperative bariatric surgery from 1985 to 1990 were observed prospectively. One, two, or three previous bariatric procedures had been performed in 77{\%}, 18{\%}, and 5{\%} of patients, respectively. Reoperation was required for unsatisfactory weight loss after gastroplasty or gastric bypass (61{\%}), metabolic complications of jejunoileal bypass (23{\%}), or other complications (16{\%}), including stomal obstruction, alkaline- or acid-reflux esophagitis, and anastomotic ulcer. Revisionary procedures included conversion to vertical banded gastroplasty (33{\%} of operations) and vertical Roux-en-Y gastric bypass (52{\%} of operations); partial pancreato-biliary bypass was used selectively in four patients with severe, medically complicated obesity. Results. A single patient died postoperatively of a pulmonary embolus; serious morbidity occurred in 11{\%}. Weight loss (̄X ± SEM) after reoperation for unsuccessful weight loss was greater with gastric bypass than with vertical banded gastroplasty (54 ± 6{\%} versus 24 ± 6{\%} of excess body weight). Metabolic complications of jejunoileal bypass were corrected, but 67{\%} of the patients were dissatisfied with their postoperative lifestyle because of changes in eating habits or weight gain (64{\%} of patients). Stomal complications and esophageal reflux symptoms were reversed in all patients. Conclusions. Reoperative bariatric surgery in selected patients is safe and effective for unsatisfactory weight loss or for complications of previous bariatric procedures. Conversion to gastric bypass provides more effective weight loss than vertical banded gastroplasty.",
author = "Behrns, {K. E.} and Smith, {C. D.} and Kelly, {K. A.} and Sarr, {M. G.}",
year = "1993",
language = "English (US)",
volume = "218",
pages = "646--653",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Reoperative bariatric surgery

T2 - Lessons learned to improve patient selection and results

AU - Behrns, K. E.

AU - Smith, C. D.

AU - Kelly, K. A.

AU - Sarr, M. G.

PY - 1993

Y1 - 1993

N2 - Objective. The purpose of this study was to determine the spectrum of presentation, safety, and efficacy of operative bariatric surgery. Summary Background Data. The only lasting therapy for medically complicated clinically severe obesity is bariatric surgery. Several operative approaches have resulted in disappointing long-term weight loss or an unacceptable incidence of complications that require revisionary surgery. Methods. Sixty- one consecutive patients who underwent reoperative bariatric surgery from 1985 to 1990 were observed prospectively. One, two, or three previous bariatric procedures had been performed in 77%, 18%, and 5% of patients, respectively. Reoperation was required for unsatisfactory weight loss after gastroplasty or gastric bypass (61%), metabolic complications of jejunoileal bypass (23%), or other complications (16%), including stomal obstruction, alkaline- or acid-reflux esophagitis, and anastomotic ulcer. Revisionary procedures included conversion to vertical banded gastroplasty (33% of operations) and vertical Roux-en-Y gastric bypass (52% of operations); partial pancreato-biliary bypass was used selectively in four patients with severe, medically complicated obesity. Results. A single patient died postoperatively of a pulmonary embolus; serious morbidity occurred in 11%. Weight loss (̄X ± SEM) after reoperation for unsuccessful weight loss was greater with gastric bypass than with vertical banded gastroplasty (54 ± 6% versus 24 ± 6% of excess body weight). Metabolic complications of jejunoileal bypass were corrected, but 67% of the patients were dissatisfied with their postoperative lifestyle because of changes in eating habits or weight gain (64% of patients). Stomal complications and esophageal reflux symptoms were reversed in all patients. Conclusions. Reoperative bariatric surgery in selected patients is safe and effective for unsatisfactory weight loss or for complications of previous bariatric procedures. Conversion to gastric bypass provides more effective weight loss than vertical banded gastroplasty.

AB - Objective. The purpose of this study was to determine the spectrum of presentation, safety, and efficacy of operative bariatric surgery. Summary Background Data. The only lasting therapy for medically complicated clinically severe obesity is bariatric surgery. Several operative approaches have resulted in disappointing long-term weight loss or an unacceptable incidence of complications that require revisionary surgery. Methods. Sixty- one consecutive patients who underwent reoperative bariatric surgery from 1985 to 1990 were observed prospectively. One, two, or three previous bariatric procedures had been performed in 77%, 18%, and 5% of patients, respectively. Reoperation was required for unsatisfactory weight loss after gastroplasty or gastric bypass (61%), metabolic complications of jejunoileal bypass (23%), or other complications (16%), including stomal obstruction, alkaline- or acid-reflux esophagitis, and anastomotic ulcer. Revisionary procedures included conversion to vertical banded gastroplasty (33% of operations) and vertical Roux-en-Y gastric bypass (52% of operations); partial pancreato-biliary bypass was used selectively in four patients with severe, medically complicated obesity. Results. A single patient died postoperatively of a pulmonary embolus; serious morbidity occurred in 11%. Weight loss (̄X ± SEM) after reoperation for unsuccessful weight loss was greater with gastric bypass than with vertical banded gastroplasty (54 ± 6% versus 24 ± 6% of excess body weight). Metabolic complications of jejunoileal bypass were corrected, but 67% of the patients were dissatisfied with their postoperative lifestyle because of changes in eating habits or weight gain (64% of patients). Stomal complications and esophageal reflux symptoms were reversed in all patients. Conclusions. Reoperative bariatric surgery in selected patients is safe and effective for unsatisfactory weight loss or for complications of previous bariatric procedures. Conversion to gastric bypass provides more effective weight loss than vertical banded gastroplasty.

UR - http://www.scopus.com/inward/record.url?scp=0027432002&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027432002&partnerID=8YFLogxK

M3 - Article

VL - 218

SP - 646

EP - 653

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 5

ER -