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Erschienen in: Obesity Surgery 12/2010

01.12.2010 | Clinical Research

Revisional vs. Primary Roux-en-Y Gastric Bypass—a Case-matched Analysis

Less Weight Loss in Revisions

verfasst von: Urs Zingg, Alexander McQuinn, Dennis DiValentino, Steven Kinsey-Trotman, Philip Game, David Watson

Erschienen in: Obesity Surgery | Ausgabe 12/2010

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Abstract

With the increase in bariatric procedures performed, revisional surgery is now required more frequently. Roux-en-Y gastric bypass (RYGB) is considered to be the gold standard revision procedure. However, data comparing revisional vs. primary RYGB is scarce, and no study has compared non-resectional primary and revisional RYGB in a matched control setting. Analysis of 61 revisional RYGB that were matched one to one with 61 primary RYGB was done. Matching criteria were preoperative body mass index, age, gender, comorbidities and choice of technique (laparoscopic vs. open). After matching, the groups did not differ significantly. Previous bariatric procedures were 13 gastric bands, 36 vertical banded gastroplasties, 10 RYGB and two sleeve gastrectomies. The indication for revisional surgery was insufficient weight loss in 55 and reflux in 6. Intraoperative and surgical morbidity was not different, but medical morbidity was significantly higher in revisional procedures (9.8% vs. 0%, p = 0.031). Patients undergoing revisional RYGB lost less weight in the first two postoperative years compared with patients with primary RYGB (1 month, 14.9% vs. 29.7%, p = 0.004; 3 months, 27.4% vs. 51.9%, p = 0.002; 6 months, 39.4 vs. 70.4%, p < 0.001; 12 months, 58.5% vs. 85.9%, p < 0.001; 24 months, 60.7% vs. 90.0%, p = 0.003). Although revisional RYGB is safe and effective, excess weight loss after revisional RYGB is significantly less than following primary RYGB surgery. Weight loss plateaus after 12 months follow-up.
Literatur
1.
Zurück zum Zitat Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295:1549–55.CrossRefPubMed Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295:1549–55.CrossRefPubMed
2.
Zurück zum Zitat Brown VW, Fujioka K, Wilson PW, et al. Obesity: why be concerned? Am J Med. 2009;122:S4–11.CrossRefPubMed Brown VW, Fujioka K, Wilson PW, et al. Obesity: why be concerned? Am J Med. 2009;122:S4–11.CrossRefPubMed
3.
Zurück zum Zitat Greenway FL, Ryan DH, Bray GA, et al. Pharmaceutical cost savings of treating obesity with weight loss medications. Obes Res. 1999;7:523–31.PubMed Greenway FL, Ryan DH, Bray GA, et al. Pharmaceutical cost savings of treating obesity with weight loss medications. Obes Res. 1999;7:523–31.PubMed
4.
Zurück zum Zitat National Institutes of Health. Consensus statement: gastrointestinal surgery for severe obesity. Nutrition. 1996;12:397–402.CrossRef National Institutes of Health. Consensus statement: gastrointestinal surgery for severe obesity. Nutrition. 1996;12:397–402.CrossRef
5.
Zurück zum Zitat Sauerland S, Angrisani L, Belachew M, et al. Obesity surgery. Evidence-based guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc. 2005;19:200–21.CrossRefPubMed Sauerland S, Angrisani L, Belachew M, et al. Obesity surgery. Evidence-based guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc. 2005;19:200–21.CrossRefPubMed
6.
Zurück zum Zitat DeMaria EJ, Sugerman HJ, Meador JG, et al. High failure rate after laparoscopic adjustable silicone gastric banding for treatment of morbid obesity. Ann Surg. 2001;233:809–18.CrossRefPubMed DeMaria EJ, Sugerman HJ, Meador JG, et al. High failure rate after laparoscopic adjustable silicone gastric banding for treatment of morbid obesity. Ann Surg. 2001;233:809–18.CrossRefPubMed
7.
Zurück zum Zitat Jones DB, Provost DA, DeMaria EJ, et al. Optimal management of the morbidly obese patient. SAGES appropriateness conference statement. Surg Endosc. 2004;18:1029–2037.CrossRefPubMed Jones DB, Provost DA, DeMaria EJ, et al. Optimal management of the morbidly obese patient. SAGES appropriateness conference statement. Surg Endosc. 2004;18:1029–2037.CrossRefPubMed
8.
Zurück zum Zitat Weber M, Muller MK, Michel JM, et al. Laparoscopic Roux-en-Y gastric bypass, but not rebanding, should be proposed as rescue procedure for patients with failed laparoscopic gastric banding. Ann Surg. 2003;238:827–34.CrossRefPubMed Weber M, Muller MK, Michel JM, et al. Laparoscopic Roux-en-Y gastric bypass, but not rebanding, should be proposed as rescue procedure for patients with failed laparoscopic gastric banding. Ann Surg. 2003;238:827–34.CrossRefPubMed
9.
Zurück zum Zitat Martin MJ, Mullenix PS, Steele SR, et al. A case-match analysis of failed prior bariatric procedures converted to resectional gastric bypass. Am J Surg. 2004;187:666–71.CrossRefPubMed Martin MJ, Mullenix PS, Steele SR, et al. A case-match analysis of failed prior bariatric procedures converted to resectional gastric bypass. Am J Surg. 2004;187:666–71.CrossRefPubMed
10.
Zurück zum Zitat Iannelli A, Amato D, Addeo P, et al. Laparoscopic conversion of vertical banded gastroplasty (Mason MacLean) into Roux-en-Y gastric bypass. Obes Surg. 2008;18:43–6.CrossRefPubMed Iannelli A, Amato D, Addeo P, et al. Laparoscopic conversion of vertical banded gastroplasty (Mason MacLean) into Roux-en-Y gastric bypass. Obes Surg. 2008;18:43–6.CrossRefPubMed
11.
Zurück zum Zitat Cohne R, Pinheiro JS, Correa JL, et al. Laparoscopic revisional bariatric surgery. Myths and facts. Surg Endosc. 2005;19:822–5.CrossRef Cohne R, Pinheiro JS, Correa JL, et al. Laparoscopic revisional bariatric surgery. Myths and facts. Surg Endosc. 2005;19:822–5.CrossRef
12.
Zurück zum Zitat Brolin RE, Cody RP. Weight loss outcome of revisional bariatric operations varies according to the primary procedure. Ann Surg. 2008;248:227–32.CrossRefPubMed Brolin RE, Cody RP. Weight loss outcome of revisional bariatric operations varies according to the primary procedure. Ann Surg. 2008;248:227–32.CrossRefPubMed
13.
Zurück zum Zitat Coakley BA, Deveney CW, Spight DH, et al. Revisional bariatric surgery for failed restrictive procedures. Surg Obes Relat Dis. 2008;4:581–6.CrossRefPubMed Coakley BA, Deveney CW, Spight DH, et al. Revisional bariatric surgery for failed restrictive procedures. Surg Obes Relat Dis. 2008;4:581–6.CrossRefPubMed
14.
Zurück zum Zitat Nesset EM, Kendrick ML, Houghton SG, et al. A two-decade spectrum of revisional bariatric surgery at a tertiary referral center. Surg Obes Relat Dis. 2007;3:25–30.CrossRefPubMed Nesset EM, Kendrick ML, Houghton SG, et al. A two-decade spectrum of revisional bariatric surgery at a tertiary referral center. Surg Obes Relat Dis. 2007;3:25–30.CrossRefPubMed
15.
Zurück zum Zitat van Wageningen B, Berends FJ, van Ramshorst B, et al. Revision of failed laparoscopic adjustable gastric banding to Roux-en-Y gastric bypass. Obes Surg. 2006;16:137–41.CrossRefPubMed van Wageningen B, Berends FJ, van Ramshorst B, et al. Revision of failed laparoscopic adjustable gastric banding to Roux-en-Y gastric bypass. Obes Surg. 2006;16:137–41.CrossRefPubMed
16.
Zurück zum Zitat Mognol P, Chosidow D, Marmuse JP. Laparoscopic conversion of laparoscopic gastric banding to Roux-en-Y gastric bypass: a review of 70 patients. Obes Surg. 2004;14:1349–53.CrossRefPubMed Mognol P, Chosidow D, Marmuse JP. Laparoscopic conversion of laparoscopic gastric banding to Roux-en-Y gastric bypass: a review of 70 patients. Obes Surg. 2004;14:1349–53.CrossRefPubMed
17.
Zurück zum Zitat te Riele WW, Sze YK, Wiezer MJ, et al. Conversion of failed laparoscopic gastric banding to gastric bypass as safe and effective as primary gastric bypass in morbidly obese patients. Surg Obes Relat Dis. 2008;4:735–9.CrossRef te Riele WW, Sze YK, Wiezer MJ, et al. Conversion of failed laparoscopic gastric banding to gastric bypass as safe and effective as primary gastric bypass in morbidly obese patients. Surg Obes Relat Dis. 2008;4:735–9.CrossRef
18.
Zurück zum Zitat Topart P, Becouarn G, Ritz P. One-year weight loss after primary or revisional Roux-en-Y gastric bypass for failed adjustable gastric banding. Surg Obes Relat Dis. 2009;5:459–62.CrossRefPubMed Topart P, Becouarn G, Ritz P. One-year weight loss after primary or revisional Roux-en-Y gastric bypass for failed adjustable gastric banding. Surg Obes Relat Dis. 2009;5:459–62.CrossRefPubMed
19.
Zurück zum Zitat Owens BM, Owens ML, Hill CW. Effect of revisional bariatric surgery on weight loss and frequency of complications. Obes Surg. 1996;6:479–84.CrossRefPubMed Owens BM, Owens ML, Hill CW. Effect of revisional bariatric surgery on weight loss and frequency of complications. Obes Surg. 1996;6:479–84.CrossRefPubMed
20.
Zurück zum Zitat Ikramuddin S, Kellogg TA, Leslie DB. Laparoscopic conversion of vertical banded gastroplasty to a Roux-en-Y gastric bypass. Surg Endosc. 2007;21:1927–30.CrossRefPubMed Ikramuddin S, Kellogg TA, Leslie DB. Laparoscopic conversion of vertical banded gastroplasty to a Roux-en-Y gastric bypass. Surg Endosc. 2007;21:1927–30.CrossRefPubMed
21.
Zurück zum Zitat Durak E, Inabnet WB, Schrope B, et al. Incidence and management of enteric leaks after gastric bypass for morbid obesity during a 10-year period. Surg Obes Relat Dis. 2008;4:389–93.CrossRefPubMed Durak E, Inabnet WB, Schrope B, et al. Incidence and management of enteric leaks after gastric bypass for morbid obesity during a 10-year period. Surg Obes Relat Dis. 2008;4:389–93.CrossRefPubMed
22.
Zurück zum Zitat Roller JE, Provost DA. Revision of failed gastric restrictive operations to Roux-en-Y gastric bypass: impact of multiple prior bariatric operations on outcome. Obes Surg. 2006;16:865–9.CrossRefPubMed Roller JE, Provost DA. Revision of failed gastric restrictive operations to Roux-en-Y gastric bypass: impact of multiple prior bariatric operations on outcome. Obes Surg. 2006;16:865–9.CrossRefPubMed
23.
Zurück zum Zitat Chevallier JM, Paita M, Rodde-Dunet MH, et al. Predictive factors of outcome after gastric banding: a nationwide survey on the role of center activity and patients’ behaviour. Ann Surg. 2007;246:1034–9.CrossRefPubMed Chevallier JM, Paita M, Rodde-Dunet MH, et al. Predictive factors of outcome after gastric banding: a nationwide survey on the role of center activity and patients’ behaviour. Ann Surg. 2007;246:1034–9.CrossRefPubMed
24.
Zurück zum Zitat Burgmer R, Grigutsch K, Zipfel S, et al. The influence of eating behaviour and eating pathology on weight loss after gastric restriction operations. Obes Surg. 2005;15:684–91.CrossRefPubMed Burgmer R, Grigutsch K, Zipfel S, et al. The influence of eating behaviour and eating pathology on weight loss after gastric restriction operations. Obes Surg. 2005;15:684–91.CrossRefPubMed
25.
Zurück zum Zitat Song, Fernstrom MH. Nutritional and psychological considerations after bariatric surgery. Aesthet Surg. 2008;28:195–9.CrossRef Song, Fernstrom MH. Nutritional and psychological considerations after bariatric surgery. Aesthet Surg. 2008;28:195–9.CrossRef
26.
Zurück zum Zitat Sarwer DB, Wadden TA, Moore RH, et al. Preoperative eating behaviour, postoperative dietary adherence, and weight loss after gastric bypass surgery. Surg Obes Relat Dis. 2008;4:640–6.CrossRefPubMed Sarwer DB, Wadden TA, Moore RH, et al. Preoperative eating behaviour, postoperative dietary adherence, and weight loss after gastric bypass surgery. Surg Obes Relat Dis. 2008;4:640–6.CrossRefPubMed
27.
Zurück zum Zitat Courcoulas A, Perry Y, Buenaventura P, et al. Comparing the outcomes after laparoscopic versus open gastric bypass: a matched paired analysis. Obes Surg. 2003;13:341–6.CrossRefPubMed Courcoulas A, Perry Y, Buenaventura P, et al. Comparing the outcomes after laparoscopic versus open gastric bypass: a matched paired analysis. Obes Surg. 2003;13:341–6.CrossRefPubMed
28.
Zurück zum Zitat Lujan JA, Frutos MD, Hernandez Q, et al. Laparoscopic versus open gastric bypass in the treatment of morbid obesity. A randomized prospective trial Ann Surg. 2004;239:433–7. Lujan JA, Frutos MD, Hernandez Q, et al. Laparoscopic versus open gastric bypass in the treatment of morbid obesity. A randomized prospective trial Ann Surg. 2004;239:433–7.
29.
Zurück zum Zitat Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;3:279–91.CrossRef Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;3:279–91.CrossRef
30.
Zurück zum Zitat Gagner M, Gumbs AA. Gastric banding: conversion to sleeve, bypass, or DS. Surg Endosc. 2007;21:1931–5.CrossRefPubMed Gagner M, Gumbs AA. Gastric banding: conversion to sleeve, bypass, or DS. Surg Endosc. 2007;21:1931–5.CrossRefPubMed
31.
Zurück zum Zitat Hallowell PT, Stellato TA, Yao DA, et al. Should bariatric revisional surgery be avoided secondary to increased morbidity and mortality. Am J Surg. 2009;197:391–6.CrossRefPubMed Hallowell PT, Stellato TA, Yao DA, et al. Should bariatric revisional surgery be avoided secondary to increased morbidity and mortality. Am J Surg. 2009;197:391–6.CrossRefPubMed
32.
Zurück zum Zitat Tucker O, Sucandy I, Szomstein S, et al. Revisional surgery after failed laparoscopic adjustable banding. Surg Obes Relat Dis. 2008;4:740–7.CrossRefPubMed Tucker O, Sucandy I, Szomstein S, et al. Revisional surgery after failed laparoscopic adjustable banding. Surg Obes Relat Dis. 2008;4:740–7.CrossRefPubMed
Metadaten
Titel
Revisional vs. Primary Roux-en-Y Gastric Bypass—a Case-matched Analysis
Less Weight Loss in Revisions
verfasst von
Urs Zingg
Alexander McQuinn
Dennis DiValentino
Steven Kinsey-Trotman
Philip Game
David Watson
Publikationsdatum
01.12.2010
Verlag
Springer-Verlag
Erschienen in
Obesity Surgery / Ausgabe 12/2010
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-010-0214-z

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