Revisional surgeries common after bariatric surgery

1. Over one quarter of patients required revision surgery (including conversion to another procedure, corrective surgery, and reversal surgery) after initial bariatric surgery in a cohort of Swedish patients.

2. Revision surgery was much less common after gastric bypass compared with banding or vertical banded gastroplasty.

Evidence Rating Level: 2 (Good).

Study Rundown: Obesity is one of the most common medical conditions across the world, and prevalence continues to rise. Although bariatric surgery is one of the few therapies with proven benefit, revision surgery is not uncommon. However, most of the existing data examining revision surgery rates was typically limited in follow up time.

This was a prospective cohort study in Sweden using the Swedish Obese Subjects (SOS) database with over 2000 patients followed for between 13 and 26 years after banding, vertical banded gastroplasty (VBG), or gastric bypass surgery (GBS). The study found that revision surgery (including conversion to another procedure, correction of initial procedure, or reversal to normal anatomy) was more common after banding or VBG compared with gastric bypass. After both banding or VBG, the most common revision surgery was a conversion surgery (usually to gastric bypass). The large sample size and long term follow up both support this study’s findings, which further inform practitioners and patients regarding revision surgery rates and indications after bariatric surgery. The nonrandomized design may have introduced bias in the choice of initial surgery and contributed to the rates of revisions.

Click to read the study in JAMA Surgery

Relevant Reading: Long-term Follow-up After Bariatric Surgery: A Systematic Review

In-Depth [prospective cohort]: This was a prospective cohort study using the Swedish Obese Subjects (SOS) database which recruited patients across multiple centers in Sweden who had bariatric surgery (either banding, vertical band gastroplasty, or gastric bypass) between September 1987 and January 2001. There were 2010 patients recruited (of which 2007 underwent an operation) and followed until December 2014 (follow up range 13-26 years). Inclusion criteria were age 37-60, BMI 34 or greater if male and 38 or greater if female. Surgery breakdown was as follows: 376 (18.7%) had banding, 1365 (67.9%) had VBG, and 266 (13.2%) had GBS. A total of 559 patients (27.8%) had a first-time revision surgery (defined as conversion to another procedure, corrective surgery, or reversal surgery). Conversion surgeries were significantly more common after banding (40.7%) and VBG (28.3%) than GBS (7.5%). Conversions were significantly more common in women compared with men (12.9 vs 9.6 per 1000 person-years, p=0.04) and in those younger than median age compared with older (14.7 vs 8.6 per 1000 person-years, p=0.001). Corrections were nearly 4 times more common in women then in men (4.3 vs 1.1 per 1000 person-years, p=0.001).

Image: PD

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