A large medical database has recently been analyzed, and the results show that revision bariatric surgery does not pose the excessive risk it initially thought. Originally, it was believed that there was an increase in morbidity and mortality rates from re-operative bariatric surgery. The new research suggests that the differences between a first surgery and a second bariatric surgery may be nominal in most cases after all.
A digestive disorders specialist named Dr. Ranjan Sudan (vice-chair of education in surgery at Duke University, Durham, North Carolina) believes that the findings should interest those deciding whether to undergo a second surgery or not. Currently, most insurance companies and facilities restrict access to re-operative or second bariatric surgeries to patients with a failed first surgery or a medical need for corrective surgery.
Bariatric Surgery Revision Options
The most popular weight loss surgery reoperation procedures include;
- Gastric Sleeve Revision
- Sleeve to Sleeve (Resleeve)
- Banded Sleeve Gastrectomy (GaBP Ring Autolock™ System)
- Sleeve to Mini Bypass
- Sleeve to RNY Gastric Bypass
- Sleeve to Duodenal Switch
- Gastric Bypass Revision
- RNY to RNY Revision
- RNY to DS
- Gastric Banding (Lap-Band) Revision
- Lap Band to Gastric Sleeve
- Lap Band to Gastric Bypass
Older bariatric procedures like Vertical Banded Gastroplasty (VBG) must be revised to gastric sleeve or bypass. In most cases, these procedures have been performed via open surgery and may not be feasible to be re-operated laparoscopically.
Study on Re-Operative Bariatric Surgery
The American Society for Metabolic and Bariatric Surgery (ASMBS), led by Dr. Sudan, analyzed the data of over 450,000 operations conducted over the 5-year period ending in the spring of 2012. The procedures were performed with approximately 1,000 surgeons and over 700 hospitals, as the Clinical Endocrinology News reported.
The comparison was of how many serious 30-day incidents happened, such as gastric leaks, bleeding, and pulmonary embolism, between the initial weight loss surgery and the pre-operative or second surgery. The results showed that 1.61 percent of the primary procedures and 1.66 percent of the preoperative procedures had one of the listed complications. The difference between the first surgery and the second one is nominal and not that much more from one to the other.
In addition to the serious issue incidents, the study also compared the differences in mortality of the patients undergoing the revisional surgeries. At the 30-day mark, the primary surgery patients had a mortality rate of 0.1 percent and then 0.17 percent at the one-year point.
The patients with re-operative surgery had a rate of 0.14 percent of mortality during surgery, with a rate of 0.26 percent at the one-year point after surgery. This analysis’s differences were also very nominal and seemed to indicate that a second surgery was no more dangerous than a first.
These findings suggest that the original belief of bariatric surgery re-operative instances posed a great danger to patients over the first surgery. Dr. Sudan believes that a re-operative option for bariatric surgery patients is necessary and should be available to patients if there is little or no further danger over the first surgery. Many patients need re-operative surgery to fine-tune their first surgery and improve their weight loss. Also, there is a need for corrective surgeries to help make adjustments that might be necessary after the first surgery has been completed, and the results are marked.
During the 2014 Annual Digestive Disease Week conference, the presenters showed that patients’ benefits far outweigh the potential hazards related to secondary surgeries. This is positive for all concerned and will mean better results for many patients who cannot access these operations. It will give surgeons more ability to get the patient’s results and ensure they stay on the path to success in their weight loss efforts.
The new information should help insurance companies and facilities provide better coverage for their insured individuals. Secondary surgeries are thought to be more dangerous in both the weight loss surgery profession and other fields, such as bypass grafting and heart valve surgery. It is believed that the reduced instances of extreme danger for patients mean they will have better access to the operations needed to improve their health.