Cause analysis and treatment of reoperative metabolic and bariatric surgery:A report of 54 cases / 中国实用外科杂志

ABSTRACT

OBJECTIVE: To explore the cause and treatment of bariatric and metabolic surgery reoperation. METHODS: A retrospective analysis was conducted on the clinical data of 54 patients underwent reoperative metabolic and bariatric surgery in Department of Bariatric and Metabolic Surgery,the First Affiliated Hospital of Jinan University from November 2000 to December 2018, and the reasons and surgical techniques of reoperation were analyzed. RESULTS: Causes of reoperation included inadequate weight loss/weight regain in 22 cases(40.7%),adhesive intestinal obstruction in 5 cases(9.3%),mesenteric hernia in 5 cases(9.3%),gastroesophageal reflux in 4 cases(7.4%),anastomotic leakage4 cases(7.4%),anastomotic ulcer bleeding in 3 cases(5.6%),anastomotic stenosis in 3 cases(5.6%),postoperative intraabdominal bleeding in 3 cases(5.6%),recurrent diabetes in 2 cases(3.7%),severe dumping syndrome in 2 cases(3.7%),anastomotic error in 1 case(1.9%). Reoperation methods mainly included Roux-en-Y gastric bypass in 30 cases(55.6%),sleeve gastrostomy in 10 cases(18.5%),hernia repair in 5 cases(9.3%),exploratory laparotomy hemostasis in 4 cases(7.4%),gastroscopic balloon dilatation in 2 cases(3.7%),restoration surgery in 1 case(1.9%),revisional banded gastric bypass with GaBP ring in 1 case(1.9%), hiatal hernia repair in 1 case(1.9%). A total of 54 patients underwent reoperation with a follow-up period of 1 to 102 months. Among them, 42 patients were followed up,and 12 patients were lost to follow-up(follow-up rate of 77.8%). Among the 42 patients who were followed up, 41 of them achieved good results after surgery, and the symptoms and signs were relieved to various degrees. CONCLUSION: The most common cause of reoperative metabolic and bariatric surgery is inadequate weight loss/weight regain.The choice of reoperation method depends on the primary surgical procedure, the cause of failure, and the intraoperative condition.