Embracing the second chance: efficacy and safety of revisional bariatric surgery for weight regain

Aim: Weight recidivism following bariatric surgery has major physical and psychological consequences. Revisional surgery is a common management option but is associated with increased complications compared to primary surgery. The objective of this study was to assess the efficacy and safety of revisional bariatric surgery for weight regain at our institution. Methods: A retrospective database review identified patients who underwent revisional bariatric surgery for weight regain at our institution from 2014 to 2023. Emergent operations were excluded. The primary outcomes were percentage total (%TWL) and excess weight loss (%EWL) using revisional surgery weight as the baseline. Secondary outcomes were 30-day morbidity, mortality, readmission, and reoperation rates. Results: Seventy patients were identified. Five types of revisional procedures were performed: 39 (55.7%) Roux-en-Y gastric bypass (RYGB) revisions (21 endoscopic, 11 laparoscopic, 6 robotic, 1 open), 15 (21.4%) sleeve gastrectomy (SG) to one-anastomosis gastric bypass (OAGB) conversions (8 robotic, 7 laparoscopic), 8 (11.4%) SG revisions (7 laparoscopic, 1 robotic), 7 (10.0%) laparoscopic gastric band to SG conversions, and 1 (1.4%) laparoscopic gastric band to OAGB conversion. SG to OAGB conversion had the largest mean 12-month %EWL at 67.9 ± 25.1, which was significantly greater than SG revision at 47.4 ± 6.7 (P = 0.04) and gastric band to SG conversion at 44.1 ± 21.1 (P = 0.04). SG to OAGB conversion also had the largest mean 12-month %TWL at 19.1 ± 9.4, significantly greater than RYGB revision at 9.0 ± 6.0 (P < 0.001). The 30-day morbidity rate for all patients was 7.1% (N = 5), including 1 anastomotic leak following an SG revision requiring 1 reoperation (1.4%). The 30-day readmission rate was 5.7% (N = 4) and there were no 30-day mortalities. Conclusion: Revisional bariatric surgery is an effective tool for addressing weight regain and achieving sustained weight loss. Among the revisional options, converting SG to OAGB was most effective at promoting significant weight loss at 12 months. These findings highlight the important role of tailored revisional procedures in the broader context of bariatric care.