A case-match analysis of failed prior bariatric procedures converted to resectional gastric bypass

• Published in: The American journal of surgery 2004-05, Vol.187 (5), p.666-671
• Main Authors: Martin, Matthew J, Mullenix, Philip S, Steele, Scott R, See, Craig S, Cuadrado, Daniel G, Carter, Preston L
• Format: Article
• Language: English
• Subjects: Bariatric surgery; Blood Loss, Surgical - statistics & numerical data; Body Mass Index; Body Weight; Comorbidity; Complications; Deglutition Disorders - etiology; Dysphagia; Esophagitis - etiology; Female; Gastrectomy - adverse effects; Gastrectomy - methods; Gastrectomy - statistics & numerical data; Gastric bypass; Gastric Bypass - adverse effects; Gastric Bypass - methods; Gastric Bypass - statistics & numerical data; Gastrointestinal surgery; Humans; Hypertension; Length of Stay - statistics & numerical data; Male; Middle Aged; Obesity; Obesity, Morbid - surgery; Ostomy; Patient Selection; Patients; Peptic Ulcer - etiology; Prospective Studies; Reoperation; Reoperation - adverse effects; Reoperation - methods; Reoperation - statistics & numerical data; Single-Blind Method; Small intestine; Time Factors; Treatment Failure; Ulcers; Vitamin deficiency; Vomiting - etiology; Weight control; Weight Loss
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2004.02.002

Failure to lose weight or intractable symptoms after bariatric surgery presents a complex diagnostic and management challenge. The outcome of a standardized surgical approach to this problem has not been well described. Conversion of failed bariatric procedures to a resectional gastric bypass (RGB) can achieve symptomatic relief and acceptable weight loss. We reviewed all patients in a prospectively maintained database who underwent reoperative bariatric surgery over a 4-year period. Reoperative patients (RO) were case-matched (by age, body mass index, and comorbidities) in a 1:2 ratio with control patients undergoing an initial bariatric procedure (IN). Twenty-seven reoperative patients and 54 case-matched control patients were identified. Mean body mass index was 42 in the RO group versus 45 in the IN group ( P = not significant). Indications for conversion were weight gain (89%), dysphagia/emesis (30%), esophagitis (19%), and marginal ulcer (7%). All patients in both groups underwent RGB (subtotal gastrectomy with Roux-Y gastrojejunostomy). Compared with IN patients, the RO patients had significantly longer operative times (420 versus 268 minutes), greater blood loss (650 versus 315 cc), longer time to oral intake (3.1 versus 2.2 days), and longer hospital stays (6.5 versus 4.7 days), all P