Original articles|Articles in Press

Bariatric Surgeon Perspective on Revisional Bariatric Surgery (RBS) for Weight Recurrence


      • 98% of surgeons suggested that WR is multifactorial
      • Conversion of SG to RYGB was the most common RBS (22%)
      • Failure of PBS was defined as EWL<50% by 31%
      • The definition of failure of PBS differed significantly by surgeon gender



      Weight recurrence (WR) after bariatric surgery occurs in nearly 20% of patients. Revisional bariatric surgery (RBS) may benefit this population but remains controversial among surgeons.


      Explore surgeon perspectives and practices for patients with WR after primary bariatric surgery (PBS)


      Web-based survey of bariatric surgeons


      A 21-item survey was piloted and posted on social media closed groups (Facebook) utilized by bariatric surgeons. Survey items included demographic information, questions pertaining to the definition of suboptimal and satisfactory response to bariatric surgery, and general questions related to different WR management options.


      110 surgeons from 19 countries responded to the survey. 98% responded that WR was multifactorial, including behavioral and biological factors. Failure of PBS was defined as excess weight loss (EWL) <50% by 31.4%, as EWL<25% by 12.8%, and as comorbidity recurrence by 17.4%. Surgeon responses differed significantly by gender (p= 0.036). 29.4% believed RBS was not successful, while 14.1% were unsure. Nevertheless, 73% reported that they would perform RBS if sufficient evidence of benefit existed. Most frequently performed revisional procedures included conversion of sleeve gastrectomy to Roux-en-Y gastric bypass (RYGB), adjustable gastric band to RYGB, and RYGB revision (21.9% vs. 18.2% vs. 15.3%, respectively).


      This survey demonstrates significant variability in surgeon perception regarding causes and the effectiveness of RBS. Moreover, they disagree on what constitutes a non-satisfactory response to PBS and to whom they offer RBS. These findings may relate to limited available clinical evidence on best management options for this patient population. Clinical trials investigating the comparative effectiveness of various treatment options are needed.


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