Revisional bariatric surgery appears to be associated with a higher risk of complications than the initial procedure, according to a report in the February issue of Archives of Surgery, one of the JAMA/Archives journals.
Surgical treatment is currently the only effective approach for long-term weight loss in the severely obese, according to background information in the article. "During the last decade, there has been a marked increase in the number of bariatric operations performed annually, which coincides with the increased acceptance and demand of these procedures worldwide," the authors write. "The evolution of bariatric surgery has also led to a rapidly increasing demand for revisional bariatric procedures following the discontinuation of surgical techniques favored in the past that had unsuccessful weight loss results or other complications in the long term." Rates of second bariatric operations are reported to be anywhere from 5 percent to 56 percent.
Charalambos Spyropoulos, M.D., and colleagues at the University Hospital of Patras, Rion, Greece, studied 56 patients (average age 39.6, average body mass index 46.9) who underwent revisional bariatric surgery at one institution between 1995 and 2008. The patients had three primary reasons for undergoing revisions: 39 had unsatisfactory weight loss after their initial procedure, 15 had severe nutritional complications such as protein malnutrition and two had intolerable adverse effects, including blocking or narrowing of the digestive tract.
The participants were followed for an average of 102 months. None died, but 19 patients (33.9 percent) had serious complications within 30 to 90 days, including internal leakage from the surgical site, acute kidney failure and pneumonia. Late complications (after more than 90 days) were experienced by 13 patients (23.2 percent) and included development of a hernia at the incision site, narrowing of the passageway between the stomach and intestine and low levels of albumin in the blood.