Revisional Bariatric Surgery

Bariatric surgery — also known as metabolic or weight-loss surgery — is a group of surgical procedures used to manage obesity and related conditions, with long-term weight loss achieved through alteration of gut hormones, physical reduction of stomach size, reduction of nutrient absorption, or a combination of these. Standard-of-care procedures include Roux-en-Y gastric bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch. A proportion of patients later require a further operation, whether to manage a complication or because earlier weight loss has been insufficient. Reported reoperation rates vary by the original procedure: in one analysis the percentage of procedures requiring reoperation due to complications was 8% for adjustable gastric banding, 6% after Roux-en-Y gastric bypass, 1% for sleeve gastrectomy and 5% after biliopancreatic diversion. Over a ten-year comparison, 9% of patients who received a sleeve gastrectomy required some form of reoperation within five years, compared with 12% of those who received a Roux-en-Y gastric bypass; both were fewer than the rates reported with adjustable gastric banding. Weight-loss surgery in adults carries an elevated risk of complications compared with non-surgical treatment, and complications are grouped into early events within 30 days of surgery and late events after 30 days. Overall mortality is low, reported at 0 to 0.01%, and morbidity is also low at around 5%; severe complications such as gastric perforation or necrosis have been significantly reduced by improved surgical experience and training.

Laparoscopic bariatric surgery requires an average hospital stay of about 2 to 5 days, barring complications, and patients are followed closely by a healthcare team that may include dietitians and weight-management specialists. Diet is reintroduced in stages: immediately after surgery the person is restricted to a clear liquid diet, such as broth, diluted fruit juices or sugar-free drinks, until the gastrointestinal tract begins to recover, roughly 2 to 3 weeks after surgery. A puréed or soft-solid, high-protein diet follows. Patients must learn to eat more slowly and avoid eating past fullness, since overeating can cause nausea and vomiting. Alcohol is avoided completely for the first 6 months to a year, and a daily multivitamin may be taken to offset reduced nutrient absorption.