Impact and Effectiveness of Revisional Bariatric Surgery on Nutrition and Other Patient-Related Outcomes: A Literature Revie.

Abstract

Background: Revisional bariatric surgery (RBS) for primary procedures is increasing due either to weight loss failure or complications of previous surgery. Highest incidences reported recently have been of historical vertical banded gastroplasty. However, compared to primary procedures, literature suggests that RBS may result in a higher risk of complications including nutritional deficiencies, in addition to less weight loss. Aim: To identify the impact of RBS on nutrition and other patient-related outcomes. Methodology: A search of electronic databases (PubMed, Medline, and Scopus) without date limit, and a manual search of references was applied to identify studies evaluating post-revision nutrition and other patient-related outcomes for adults seeking weight improvement. Results: 12 eligible studies evaluating different types of RBS, mainly malabsorptive procedures, were included in this review. In the majority of the studies, revisional Roux-en-Y gastric bypass (r-RYGB) resulted in a modest reduction of body mass index by ≤6.8 kg/m², while a more successful reduction of ≤15.7 kg/m² was reported after other malabsorptive procedures such as duodenal switch (DS). However, unlike single-anastomosis duodeno-ileal bypass (SADI), most RBS showed an incidence of several postoperative complications, which reached up to 25% after DS. Further, several nutritional deficiencies were reported post-revision, in particular, iron and vitamin-B12 deficiencies as the most common after r-RYGB, whereas fat-soluble vitamins deficiency was evident after revisional biliopancreatic diversion with duodenal switch. However, high remission rates of co-morbidities were reported post-revision, alongside the resolution of functional problems such as gastroesophageal reflux disease (GERD), particularly after r-RYGB. Findings regarding sleeve gastrectomy (SG) as revisional surgery were inconclusive. Conclusion: RBS, especially malabsorptive procedures, can provide additional weight loss and potential improvement in the quality of life through resolution of co-morbidities and functional problems; however, several complications including nutritional deficiencies can develop. However, r-RYGB may be recommended for correction of previous GERD, while SADI seems to be appropriate for patients seeking far more weight loss. Further large high-quality studies with a longer follow-up, are required, especially on SG as revisional surgery.