Medium-Term Outcomes of Revisional Gastric Bypass

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comorbidities; duration of surgery; early (

Medium-Term Outcomes of Revisional Gastric Bypass after failed Gastric Banding vs. Primary Gastric Bypass A Matched Case-Control Study

André Costa Pinho, Hugo Santos Sousa, André Pereira, Eduardo Lima Costa, Silvestre Carneiro, José Barbosa, John Preto, J. Costa-Maia (corresponding author: André Costa Pinho e-mail: [email protected]) Centro Hospitalar de São João Porto - Portugal

Introduction: Many patients require additional bariatric procedures after failed adjustable gastric band (AGB). In those patients Revisional Gastric Bypass (R-GB) is the most often indicated surgery but outcomes and complications may not be similar to Primary Gastric Bypass (P-GB). The objectives of this study were to compare weight loss outcomes, surgical complications and resolution of comorbidities 3 to 5 years after R-GB and P-GB.

Methods: Between 2010 and 2017, 334 (14.9% of 2247) patients were submitted to revisional procedures. The 50 first consecutive R-GB after failed AGB were selected and a group of 50 patients submitted to P-GB were matched regarding age, gender and BMI. The following variables were compared: demographics; pre-operative weight, height, BMI and obesity-related comorbidities; duration of surgery; early (50

R-GB

P-GB

Resolution of co-morbidities (%)

MEAN %TWL AT LAST FOLLOW UP

R-GB

75,0

11

55,6

8 50,0 44,0 6

37,5 31,8 28,6

2,9 2,4

0 DIABETES

DYSLIPIDEMIA

P-GB

R-GB

P-GB

R-GB

OSA

MEAN DURATION OF SURGERY (HOURS)

TOTAL COMPLICATIONS

P-GB

REOPERATIONS

0

R-GB

Late Complications (>90days)

Reoperations

Trocar hernia Intra-abdominal hemorrhage Respiratory complication

4 Trocar hernias Anastomotic stricture Small-bowel obstruction 2 Severe hypoglicemias Esophageal reflux Anastomotic stricture

5 Hernia corrections Control of mesentery hemorrhage

0

0

CONVERSION TO OPEN SURGERY

Early Complications (50 N (%) *

31 (67.4)

43 (91.5)

0.005

TWL at last follow up (kg) mean ± SD

29.7 ± 14.4

35.6 ± 10.2

0.024

%TWL at last follow up mean ± SD

24.7 ± 10.6

30.6 ± 6.9

0.002

Duration of surgery (min) mean ± SD

172.9 ± 47.2

142.4 ± 33.5

24months were included

Conclusion: Weight loss and safety outcomes of R-GB are inferior to those of P-GB. Nonetheless a mean %EWL of 58.4% in R-GB at medium term follow-up must be considered a fair result in this difficult set of patients. Furthermore, although reoperation rate is greater after R-GB the majority of cases are due to trocar hernias. No conversions to open surgery and no mortality were observed in both groups.