Revisional vs. Primary Roux-en-Y Gastric Bypass-a Case-matched Analysis: Less weight loss in revisions

Urs Zingg, Alexander McQuinn, Dennis DiValentino, Steven Kinsey-Trotman, P Game, David Watson

    Research output: Contribution to journalArticlepeer-review

    54 Citations (Scopus)

    Abstract

    With the increase in bariatric procedures performed, revisional surgery is now required more frequently. Roux-en-Y gastric bypass (RYGB) is considered to be the gold standard revision procedure. However, data comparing revisional vs. primary RYGB is scarce, and no study has compared non-resectional primary and revisional RYGB in a matched control setting. Analysis of 61 revisional RYGB that were matched one to one with 61 primary RYGB was done. Matching criteria were preoperative body mass index, age, gender, comorbidities and choice of technique (laparoscopic vs. open). After matching, the groups did not differ significantly. Previous bariatric procedures were 13 gastric bands, 36 vertical banded gastroplasties, 10 RYGB and two sleeve gastrectomies. The indication for revisional surgery was insufficient weight loss in 55 and reflux in 6. Intraoperative and surgical morbidity was not different, but medical morbidity was significantly higher in revisional procedures (9.8% vs. 0%, p∈=∈0.031). Patients undergoing revisional RYGB lost less weight in the first two postoperative years compared with patients with primary RYGB (1 month, 14.9% vs. 29.7%, p∈=∈0.004; 3 months, 27.4% vs. 51.9%, p∈=∈0.002; 6 months, 39.4 vs. 70.4%, p∈<∈0.001; 12 months, 58.5% vs. 85.9%, p∈<∈0.001; 24 months, 60.7% vs. 90.0%, p∈=∈0.003). Although revisional RYGB is safe and effective, excess weight loss after revisional RYGB is significantly less than following primary RYGB surgery. Weight loss plateaus after 12 months follow-up.

    Original languageEnglish
    Pages (from-to)1627-1632
    Number of pages6
    JournalObesity Surgery
    Volume20
    Issue number12
    DOIs
    Publication statusPublished - 1 Dec 2010

    Keywords

    • Case-matched analysis
    • Revisional surgery
    • Roux-en-Y gastric bypass
    • Weight loss

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