A. Mokhtari1, T. Mokhtari1, L. Voller1, J. Morton1 1Stanford University,Bariatric & Minimally Invasive Surgery,Palo Alto, CA, USA
Introduction: Re-operative bariatric surgery following non-response to adjustable gastric banding (AGB) or sleeve gastrectomy (SG) is generally accepted and safe with conversion to laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). While studies have reported reduced weight loss after re-operative procedures, the impact of revisional procedures on comorbidities has yet to be investigated.
Methods: 2,380 patients undergoing bariatric surgery at a single academic institution were prospectively followed in a defined data registry included 42 re-operative subjects with recorded data (13 AGB to SG; 20 AGB to RYGB; 9 SG to RYGB). Biomarkers for diabetes, cardiac risk, and inflammation including HbA1c, total cholesterol (TC), triglycerides (TG), LDL, TG/HDL ratio, and CRP were collected at preop and 6-months postop.
Results:
Demographic distribution for participants undergoing revisional surgery was 92% female, mean age 48 years, preop BMI 42.4 kg/m2. Participants undergoing revisional SG after primary (1°) AGB lost significantly less weight than those undergoing primary SG (6-month percent excess weight loss, %EWL-6 38.0 vs 53.1%, p=0.03). Gastric bands were present for 46 months with average BMI decrease of 3.3 points over this time and median time between band removal and subsequent re-operative SG was 4.7 months. Participants undergoing revisional RYGB after 1°AGB also lost significantly less weight than those undergoing 1° RYGB (%EWL-6, 47.0 vs 60.3%, p = 0.01); average band duration was 39 months prior to removal with mean BMI decreasing 4.1 points and median time between band removal and subsequent re-operative RYGB 3.7 months. For patients undergoing re-operative RYGB following SG, weight loss at 6 months was also significantly lower than those patients undergoing 1° RYGB (%EWL-6, 45.7 vs 60.3%, p=0.05). Participants experienced improved glycemic control upon bariatric re-operation following 1° AGB as evidenced by improved HbA1c 6-months following re-operative surgery (14.0% decrease after 2° SG and 17.2% following RYGB); there were no significant differences in these HbA1c values between 1° patients and those undergoing either 2° SG or RYGB after 1° AGB. Additionally, at the 6-month time point there was no significant difference in improvements for biochemical cardiac risk factors (including TC, TG, LDL, TG/HDL, and CRP) between re-operative SG and RYGB patients versus those undergoing the respective primary procedure (all p’s >0.05).
Conclusion: Re-operative bariatric surgery is effective with this study demonstrating that in addition to achieving significant weight loss (though less than the corresponding 1° surgery), re-operative bariatric patients experience improvements in glycemic control, biochemical cardiac risk factors, and inflammatory markers comparable to patients undergoing a primary procedure.