Background

Inadequate weight loss, weight regain, anatomical problems and worsening comorbidities are indications for revisional bariatric surgery. The laparoscopic adjustable gastric band (LAGB) and the laparoscopic sleeve gastrectomy (LSG) are both restrictive procedures that may cause severe gastro-esophageal reflux disease (GERD). Severe GERD after restrictive procedures can be effectively treated by conversion to laparoscopic Roux-en-Y gastric bypass (LRYGB). Rates of revisional surgery have increased over the last few years. Complication rates and weight loss after revisional surgery are worse than primary procedures, and it is rare that patients undergo more than one revisional procedure.

Methods

A retrospective chart review was conducted of patients who underwent bariatric surgery by a single surgeon at a community hospital from July 2008 through December 2016. All patients that required more than one revisional surgery were identified. Data collected included patient demographics, comorbid conditions, weight and BMI chronology, indications for revision, operative details, complications, and outcomes.

Results

1,792 bariatric procedures were performed between July 2008 and December 2016. 69 patients had revisional surgery to convert their primary procedure to another bariatric surgery. Three patients had more than 2 revisional surgeries. These 3 patients initially had a LAGB, then were converted to a LSG, and then required LRYGB. Severe refractory GERD with or without gastric stricture was the final indication for conversion to LRYGB. After conversion to LRYGB, there were no major complications and all patients significantly improved their GERD symptoms. Conclusion: Patients with severe refractory GERD with a prior history of LAGB converted to LSG can safely be revised to a LRYGB with good symptom resolution and weight loss. Patient selection and GERD symptoms are important when considering primary and revisional surgery.