Reoperations in bariatric surgery (Redo Bariatric Surgery) present an ever-increasing rate, given this. Therefore it is necessary to look for the factors that determine the success of these operations. Bariatric surgery is an effective and approved method of treating clinically severe obesity. However, we must recognize its limitations and realize that some patients will need repeat bariatric procedures.
The majority of bariatric patients manage to achieve satisfactory weight loss, that is > 50% excessive weight loss (Excessive Weight Loss), but approximately 15-20% do not achieve or maintain this goal.
Reoperations in bariatric surgery – Causes
- insufficient weight loss
- weight regain
- the unsatisfactory control of relevant medical comorbidities.
Reoperations in bariatric surgery – Indications
- gastroesophageal reflux
- marginal ulcers
- malnutrition
- the fistulas.
The occurrence of gastroesophageal reflux disease (GERD) is increasing after the Sleeve gastrectomy and with the great popularity of this procedure it is a serious problem for patients and surgeons in terms of quality of life, but also as a possible risk factor for Barrett’s esophagus and later for esophageal cancer. Reoperations in bariatric surgery account for approximately 7% of all bariatric surgeries in the world. In some countries, including the US, it is currently the third most common bariatric surgery overall. As the number of procedures performed continues to increase, we can assume that the demand for repeat procedures will increase.
The indications for bariatric reintervention are not well-defined. In addition, these procedures are technically more demanding and associated with a higher morbidity rate. Therefore, the patients being examined require an individual assessment of the potential benefits and risks.
Retrospective study
A retrospective study analyzed patients who underwent repeat operations in 12 bariatric centers in Poland between 2010 and 2020. The study included 529 patients. Efficacy endpoints were the rate of excess weight loss and remission of hypertension and/or type 2 diabetes.
The research findings show that greater weight regains before bariatric reoperation minimized the chances of success. Gastric bypass was associated with a greater likelihood of complete remission of hypertension and/or diabetes.
In the group undergoing bariatric surgery due to inadequate control of obesity-related comorbidities, gastric bypass was associated with greater odds of success. Bariatric procedures are proving to be an effective method of treatment for obesity and its comorbidities.
In conclusion, it appears that bariatric reoperations lead to a large percentage of achieving the final bariatric goal. The need for great expertise of the surgeon as well as extensive discussion with the patient about the factors that led to the initial unsuccessful bariatric surgery. The immediate reintervention time and the small weight gain from the initial BMI seem to have a positive effect on the final result.
Finally, gastric bypass is associated with greater success rates in controlling comorbidities, such as hypertension and type II DM.
