Revisional Bariatric Surgery Outcomes After Adjustable Gastric Banding

Overview

This retrospective study compares short-term outcomes of primary versus revisional Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) following adjustable gastric banding (AGB). It evaluates weight loss, surgical complications, and resolution of obesity-related comorbidities at 6 and 12 months postoperatively.

Background

Obesity is a growing global health challenge associated with multiple comorbidities and decreased quality of life. Bariatric surgery, including RYGB and SG, is the most effective treatment for sustained weight loss and comorbidity resolution. Adjustable gastric banding (AGB) was once popular due to its safety but has high rates of long-term complications and weight regain, often necessitating revisional surgery. Revisional procedures, mainly RYGB and SG, are increasingly performed but lack standardized guidelines regarding optimal choice and outcomes.

Data Highlights

The study retrospectively analyzed adult patients undergoing primary or revisional RYGB or SG after failed AGB in a tertiary hospital in Portugal during 2019. Data collected included demographics, comorbidities, anthropometrics, metabolic parameters, and postoperative complications at baseline, 6 months, and 12 months. Weight loss was assessed by % total weight loss (%TWL) and % excess weight loss (%EWL), with success defined as %TWL ≥ 20%, %EWL ≥ 50%, and BMI < 35 kg/m2 at 12 months. Early postoperative complications within 90 days were also recorded.

Key Findings

• Revisional bariatric surgery after failed AGB is increasingly common due to complications and inadequate weight loss.
• RYGB and SG are the most frequent revisional procedures, chosen based on patient comorbidities, preferences, and surgeon recommendation.
• RYGB is preferred for patients with hiatal hernia, GERD, esophagitis, or metabolic comorbidities like diabetes, while SG is selected for patients with inflammatory bowel disease or gastric cancer risk factors.
• Weight loss success at 12 months post-revisional surgery is defined by %TWL ≥ 20%, %EWL ≥ 50%, and BMI < 35 kg/m2.
• Early postoperative complications are monitored up to 90 days, with data collected on surgical morbidity.

Clinical Implications

Clinicians should consider patient-specific factors including comorbidities and preferences when selecting revisional bariatric procedures after failed AGB. Both RYGB and SG offer viable options with differing risk profiles and indications. Close multidisciplinary evaluation and follow-up are essential to optimize outcomes and manage complications.

Conclusion

Revisional RYGB and SG following failed AGB are effective bariatric interventions with distinct indications and outcomes. Individualized surgical planning and comprehensive perioperative care are key to improving weight loss and comorbidity resolution in this population.

References

1. World Health Organization -- Obesity and Overweight Facts
2. ASMBS Consensus Statement 2018 -- Standardized Outcomes Reporting in Metabolic and Bariatric Surgery