Given that obesity is a complex chronic disease, it is unlikely that a single bariatric procedure will durably treat a patient over the entirety of their life. Reflecting this reality, nearly 20% of bariatric procedures are now revisional, the majority being sleeve gastrectomy.
Despite the prevalence of revisional surgery there is limited understanding how of weight and wellbeing outcomes compare to primary operations. Questions also surround peri-operative safety and long-term risk of revisional procedures.
We performed a retrospective cohort analysis of sequential patients who underwent sleeve gastrectomy after a previous gastric band.
Demographics, operative and follow-up records were obtained from a prospectively maintained local bariatric database and were cross-checked against hospital records and The National Bariatric Surgery Registry for completeness.
There were 620 patients who underwent a revisional sleeve gastrectomy performed by six surgeons between 2006 and 2019. 87% of patients were female and median age was 48.
Follow-up was achieved in 88% of patients at one year, 67% at five years and 22% at ten years.
The mean BMI on day of surgery was 44kg/m2 (range 27-101kg/m2). Median weight loss at five-years was 20kg (TBWL 17%) and 26kg (TBWL 22%) at ten years. 4% of patients gained weight during follow-up (median regain was 7kg).
There were three peri-operative deaths (0.5%) and 54 patients experienced a complication including: bleeding (1.3%), wound problems (1.0%) and incisional hernia (1.1%) requiring intervention. Staple line leak was reported in 1.5% of patients. At the time of analysis, 13 patients (2%) underwent further bariatric procedures.
Sleeve gastrectomy performed as a revisional procedure can achieve both good weight loss and long-term follow-up; although the weight loss seen is lower than reported in primary series. Peri-operative risks are higher than those seen in primary surgery.
These data confirm that further studies are required to better understand how revisional surgery may be best tailored to an individual patient.