Revisional bariatric surgery due to failure of the initial technique: 25 years of experience in a specialized Unit of Obesity Surgery in Spain

Objectives: To evaluate the effectiveness of conversion surgery in a bariatric surgery unit with 25 years of experience. Method: Retrospective observational study of patients with type II obesity or higher who were reoperated by means of conversion surgery due to weight regain, residual body mass index (BMI) >35 kg/m(2) or < 50% of excess weight loss. The demographic and anthropometric data, comorbidities and perioperative data were analyzed in 5 periods of time: initial, postsurgery1, pre- surgery2, post- surgery2 and current. Results: A total of 112 patients were included, with a mean age of 40.2 years, who initially underwent vertical banded gastroplasty (VBG) (32.1%), gastric banding (GB) (23.2%), Roux-enY gastric bypass (RYGB) (21.4%) and sleeve gastrectomy (SG) (23.2%). The conversion techniques, with a median time between the two surgeries of 70 months, included: RYGB, SG, one-anastomosis gastric bypass (OAGB), shortening of the common loop (SCL) and biliopancreatic diversion (BPD). There was a reduction of the initial weight from 144.2 +/- 30.3 to 101.5 +/- 21.8 kg after surgery-1; from 115.6 +/- 24.0 to 91.5 +/- 19.0 kg after surgery-2. The weight at present is 94.7 +/- 16.4 kg, with a median follow-up of 27.5 months. Similar results were seen with the BMI. The improvement of comorbidities mainly occurred after the first intervention. Conclusions: Conversion surgery causes a weight reduction that does not exceed the loss achieved after the first surgery; however, it does manage to stabilize weight over time. The perioperative morbidity rate is acceptable and would justify its application, despite the limited impact on comorbidities. (C) 2019 AEC. Published by Elsevier Espana, S.L.U. All rights reserved.