Original article| Volume 16, ISSUE 10, P1442-1454, October 2020

Metabolic outcomes after revisional bariatric surgery: a systematic review and meta-analysis



      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.


      We performed a systematic review and meta-analysis to examine the impact of revisional bariatric surgery on obesity-related metabolic outcomes.


      University Hospital, Singapore


      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.


      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.


      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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      Linked Article

      • Revisional surgery for persistent disease, choosing wisely
        Surgery for Obesity and Related DiseasesVol. 16Issue 10
        • Preview
          As 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.
        • Full-Text
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      • Hypoabsorptive surgery is the best revisional strategy for metabolic and diabetes outcomes
        Surgery for Obesity and Related DiseasesVol. 16Issue 10
        • Preview
          I 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.
        • Full-Text
        • PDF