[Revision after failed bariatric surgery--review of complications and current therapeutic options].
ABSTRACT Obesity is increasing worldwide at an alarming rate. Particularly in Western countries, obesity and related problems have become a serious medical problem and an enormous socio-economic burden.
Currently, surgery is the only avail-able treatment for patients with severe obesity which leads to sustained weight loss and cure of co-morbidities in the majority of the patients. The increase in the number of bariatric operations and the occasional failure and complications of these surgical procedures have resulted in an increased need for revision surgery. Overall, 10-25 % of patients are expected to need a revision for failure of the primary bariatric procedure. The main indications for revision procedures are inadequate weight loss, surgery-related complications as well as surgical emergencies and long-term complications caused by malnutrition or -vitamin deficiencies. Unfortunately, there are currently no randomised trials to answer the question as to which operation should be performed in which patient and after which procedure. Decisions are often influenced by the expertise and preference of the operating surgeon as well as by patient's preference. Thus, a systematic review of published data to this complex issue appears to be helpful and important for daily surgical practise.
Revision bariatric procedures are technically more complex and associated with increased postoperative complications. These operations should basically be performed in centres with profound expertise in this field of surgery, and - whenever possible - laparoscopically. However, every abdominal surgeon should be able to diagnose and treat some acute complications. After failed restrictive procedures, revision is recommended only in cases of complications but with adequate weight loss at the time of failure. Otherwise, conversion to combined procedures should be considered. After the failure of combined procedures, further weight loss or successful treatment of complications can be achieved by adding more restriction and/or malabsorption components. The latter is associated with an increased risk of nutritional sequelae.
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ABSTRACT: While weight loss is the primary goal of bariatric procedures, the impact of quality of life (QoL), comorbidity, and surgery-related complications continue to grow. We report on our results of patients up to 12 years of follow-up undergoing laparoscopic adjustable gastric banding (LAGB). Preoperative data of 153 patients treated with LAGB were collected retrospectively. Questionnaires were sent to patients to analyze weight loss, complications, and comorbidities. QoL was assessed using the Bariatric Qualit-of-Life (BQL) questionnaire. Of the patients, 83.7% completed the questionnaire. Median follow-up was 8.7 years. Patients were divided into the following groups: Group A (band still in place), group B (band removed), and group C (revision surgery). A significant increase of excess BMI loss (EBL) was found in group A (p<0.0001): EBL was 36.1%, 42.8%, 41.8%, and 37.1% after 1, 3, 5, and 8 years, respectively. Group B showed a significant weight regain after band removal (p=0.007). One hundred ten reoperations were necessary in 67 patients (52.3%): slippage or pouch dilatation in 25.8%, band migration in 3.9%, band intolerance in 6.2%, and 62 revisions due to port complications. According to BQL, a higher EBL correlated with a significantly better assessment of QoL (p<0.0001). LAGB resulted in improvement of comorbidities and QoL in banded patients even though not all of them achieved the expected EBL. However, the high complication rate could influence patients' outcome.Obesity Surgery 10/2010; 21(4):448-56. · 3.10 Impact Factor
Article: Bariatric surgery.[show abstract] [hide abstract]
ABSTRACT: Bariatric surgery has increased in numbers, but the treatment of morbid obesity in Germany still needs improvement. The new interdisciplinary S3-guideline provides information on the appropriate indications, procedures, techniques, and follow-up care. Systematic review of the literature, classification of the evidence, graded recommendations, and interdisciplinary consensus-building. Bariatric surgery is a component of the multimodal treatment of obesity, which consists of multidisciplinary evaluation and diagnosis, conservative and surgical treatments, and lifelong follow-up care. The current guideline extends the BMI-based spectrum of indications that was previously proposed (BMI greater than 40 kg/m(2), or greater than 35 kg/m(2)with secondary diseases) by eliminating age limits, as well as most of the contraindications. A prerequisite for surgery is that a structured, conservative weight-loss program has failed or is considered to be futile. Type 2 diabetes is now considered an independent indication under clinical study conditions for patients whose BMI is less than 35 kg/m(2) (metabolic surgery). The standard laparoscopic techniques are gastric banding, gastric bypass, sleeve gastrectomy, and biliopancreatic diversion. The choice of procedure is based on knowledge of the results, long-term effects, complications, and individual circumstances. Structured lifelong follow-up should be provided and should, in particular, prevent metabolic deficiencies. The guideline contains recommendations based on the scientific evidence and on a consensus of experts from multiple disciplines about the indications for bariatric surgery, the choice of procedure, techniques, and follow-up care. It should be broadly implemented to improve patient care in this field.05/2011; 108(20):341-6. · 3.54 Impact Factor