C Rajkumar Vinayak
General Hospital Taiping, Malaysia
Title: An Introduction to Revisional Bariatric Procedures – options, challenges & outcomes
Biography
Biography: C Rajkumar Vinayak
Abstract
Introduction: Bariatric and metabolic surgery is now well established in tackling the pandemic of obesity and its complications. Although it’s safe, its long term issues such as weight recidivism, co-morbidity resolution and complications needs to be addressed. Therefore, revisional surgeries are on the rise. There are many reasons a revision is required and our series attempts to illustrate the complexities involved, options available and the challenges faced.
Methods: A total of 20 revisional procedures were performed at General Hospital Taiping over a period of 18 months by a single surgeon. Patient Demographics, indications for revision, type of initial and revisional intervention, duration of surgery, postoperative morbidity, 30-day readmissions and re-surgeries were reviewed prospectively and retrospectively.
Findings: Following, revisions were performed for the below mentioned primary surgeries – LAGB (5): 1 REMOVAL, 1 to LSG, 3 to RYGB; LSG (8): 1 RESLEEVE, 3 to MGB/OAGB, 4 to RYGB; MGB/OAGB (1): 1 to RYGB and RYGB (6): 1 REVISION of RYGB (resizing the pouch & distalization of Jejuno jejunostomy), 1 to NORMAL ANATOMY, 2 proximilization of Jejuno jejunostomy, 2 RE-DO of Jejuno jejunostomy. Morbidity - All patients’ had longer hospital stay compared to primary interventions. 2 patients were re-2 RE-DO of Jejuno jejunostomy operated within 48 hrs. & 1 at 14 days post op. All achieved significant % EWL except 1.
Conclusion: Revisional surgeries are effective but complex procedures. They can be performed safely and mortalities can be avoided in hands of high volume experienced surgeons. Complication rates are higher than primary bariatric surgery. Choosing the correct revisional procedure is of paramount importance.