Secondary Bariatric Procedures in a High-Volume Centre: Prevalence, Indications and Outcomes.

Background: Secondary bariatric procedures represent a challenge to both patients and surgeons. The objective of this study was to explore the patterns of recurrence and modalities of secondary bariatric procedures in a tertiary bariatric centre.

Materials And Methods: A retrospective analysis of patients who underwent secondary bariatric procedures after laparoscopic adjustable gastric band (AGB), sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) from April 2007 to March 2017.

Results: Overall, 3266 bariatric procedures were performed, and secondary bariatric procedures were required for 45 (1.4%) patients (28 AGB, 14 SG, 3 RYGB). Twenty-six (57.8%) patients underwent conversion to RYGB, eight (17.8%) patients underwent conversion to SG, seven (15.6%) patients were converted to duodenal switch (DS), two (4.4%) patients had revision of gastrojejunal anastomosis, one (2.2%) patient underwent revision of gastric pouch and one (2.2%) patient had replacement of AGB. Mean change in BMI and %TWL at 18 months were 8.5 ± 3.9 kg/m and 17.6 ± 8.2 respectively after revision of AGB. Mean change in BMI and %TWL at 18 months were 11.7 ± 11.2 kg/m and 18.4 ± 13.2 respectively after revision of SG. Mean change in BMI and %TWL at 18 months were 2.6 ± 3.0 kg/m and 6.9 ± 6.8 respectively after revision of RYGB. No mortality was reported after revision procedures.

Conclusion: Weight regain, inadequate weight loss and reflux were the main reasons for performing secondary bariatric procedures. The main revision procedures performed were RYGB and SG especially for failed AGB.