Abstract
Background
It has been well-established that primary bariatric surgery is effective in inducing
improvement of diabetes and other associated co-morbidities in patients with obesity.
Evidence demonstrating the influence of revisional bariatric surgery on this trajectory,
however, is lacking.
Objectives
We performed a systematic review and meta-analysis to examine the impact of revisional
bariatric surgery on obesity-related metabolic outcomes.
Setting
University Hospital, Singapore
Methods
We examined outcomes of remission and improvement of diabetes, hypertension, hyperlipidemia,
and obstructive sleep apnea. Revisional surgeries included sleeve gastrectomy, Roux-en-Y
gastric bypass, pouch revision, duodenal switch, and minigastric bypass.
Results
Our search identified 33 relevant studies including a total of 1593 patients. Meta-analysis
of proportions demonstrated a 92% improvement in diabetes with 50% achieving remission
after revisional bariatric surgery. Of patients, 81% achieved improvement of hypertension
with 33% achieving complete remission. In both groups, the highest proportion of improvement
was observed after revisional duodenal switch. Although reported by fewer studies,
a remission of hyperlipidemia was reported in 37% of patients and improvement of obstructive
sleep apnea was seen in 86% of patients.
Conclusions
Revisional bariatric surgery improves the outcomes of obesity-related co-morbidities
and should be considered in patients with persistent metabolic disease after primary
bariatric surgery.
Key words
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Article info
Publication history
Published online: June 06, 2020
Accepted:
May 29,
2020
Received:
April 13,
2020
Identification
Copyright
© 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
ScienceDirect
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- Revisional surgery for persistent disease, choosing wiselySurgery for Obesity and Related DiseasesVol. 16Issue 10
- PreviewAs the authors highlight, the rate of revisional bariatric surgery has been rising [1,2]. Further analysis reveals indications for revisional surgery vary widely. There is evidence of benefit for revisional surgery but also an increased risk for complications [3]. Additional understanding of criteria for best patient selection to apply additional surgical treatment with revision is one of the most important questions of this current era in metabolic bariatric surgery.
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- Hypoabsorptive surgery is the best revisional strategy for metabolic and diabetes outcomesSurgery for Obesity and Related DiseasesVol. 16Issue 10
- PreviewI read with great attentiveness the review and meta-analysis of Jie et al. [1] concerning metabolic outcomes after revisional bariatric surgery. With 33 studies assembling >1593 patients, they were able to demonstrate a major improvement in diabetes in 92% of patients and in half an amelioration of their hypertensive status [1]. Of no surprise, this was seen when hypoabsorptive surgery was complemented as a strategy, as duodenal switch and its variant are well known to be the most effective group of operations against diabetes.
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