TY - JOUR
T1 - Reoperations after sleeve gastrectomy
T2 - a dual academic institutional experience
AU - Lyo, Victoria
AU - Stroud, Andrea
AU - Wood, Stephanie
AU - Macht, Ryan
AU - Carter, Jonathan
AU - Rogers, Stanley
AU - Husain, Farah
N1 - Funding Information:
The authors thank Pamela Derish in the Department of Surgery at the University of California, San Francisco for editorial assistance. The authors have no commercial associations that might be a conflict of interest in relation to this article.
Publisher Copyright:
© 2022 American Society for Bariatric Surgery
PY - 2022/5
Y1 - 2022/5
N2 - Background: Although laparoscopic sleeve gastrectomy (LSG) is the most common bariatric operation performed worldwide, patients can experience complications and poor outcomes that warrant reoperations. The incidence, indications, and outcomes of reoperations are not well understood. Objective: To describe indications and outcomes for reoperations after LSG. Setting: Two academic, tertiary care hospitals. Methods: We performed a retrospective observational cohort review of institutional Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data from 2014–2018 and reviewed charts of all reoperations after LSG. We analyzed demographics, preoperative symptoms and work-up, and postoperative outcomes. Results: Fifty-seven reoperations after LSG represented 3.0% of 1965 bariatric cases performed. Most LSGs (56.1%) were performed outside our academic centers. Median time to reoperation and follow-up were 2.63 and 1.2 years, respectively. Conversion to gastric bypass was the most common reoperation (77.2%). More than half of the patients (52.6%) had multiple indications for reoperation. Reflux was the most common primary indication for reoperation (47.3%), followed by incisural strictures (20.1%), inadequate weight loss (17.5%), and leak/fistulae (12.2%). Reoperations were most successful when performed for reflux (92.5%) and oral intolerance from strictures (92%), whereas only 71.4% of leak/fistulas resolved. Surgery for inadequate weight loss resulted in total weight loss of 24.7 ± 10.1%. Complications occurred in 36.2% of cases but varied by indication. Conclusion: Symptoms and complications after LSG can persist, and patients may require reoperation. Reoperations can successfully treat the primary indications for reoperation and should be offered, but they have higher complication rates than initial operations.
AB - Background: Although laparoscopic sleeve gastrectomy (LSG) is the most common bariatric operation performed worldwide, patients can experience complications and poor outcomes that warrant reoperations. The incidence, indications, and outcomes of reoperations are not well understood. Objective: To describe indications and outcomes for reoperations after LSG. Setting: Two academic, tertiary care hospitals. Methods: We performed a retrospective observational cohort review of institutional Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data from 2014–2018 and reviewed charts of all reoperations after LSG. We analyzed demographics, preoperative symptoms and work-up, and postoperative outcomes. Results: Fifty-seven reoperations after LSG represented 3.0% of 1965 bariatric cases performed. Most LSGs (56.1%) were performed outside our academic centers. Median time to reoperation and follow-up were 2.63 and 1.2 years, respectively. Conversion to gastric bypass was the most common reoperation (77.2%). More than half of the patients (52.6%) had multiple indications for reoperation. Reflux was the most common primary indication for reoperation (47.3%), followed by incisural strictures (20.1%), inadequate weight loss (17.5%), and leak/fistulae (12.2%). Reoperations were most successful when performed for reflux (92.5%) and oral intolerance from strictures (92%), whereas only 71.4% of leak/fistulas resolved. Surgery for inadequate weight loss resulted in total weight loss of 24.7 ± 10.1%. Complications occurred in 36.2% of cases but varied by indication. Conclusion: Symptoms and complications after LSG can persist, and patients may require reoperation. Reoperations can successfully treat the primary indications for reoperation and should be offered, but they have higher complication rates than initial operations.
KW - Hiatal hernia
KW - Reflux after sleeve
KW - Reoperation after sleeve gastrectomy
KW - Revisional bariatric surgery
KW - Sleeve stenosis
KW - Weight regain
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U2 - 10.1016/j.soard.2022.01.015
DO - 10.1016/j.soard.2022.01.015
M3 - Article
C2 - 35181221
AN - SCOPUS:85124648810
SN - 1550-7289
VL - 18
SP - 641
EP - 649
JO - Surgery for Obesity and Related Diseases
JF - Surgery for Obesity and Related Diseases
IS - 5
ER -