Robert E Brolin1, Muhammad Asad. 1. Department of Surgery, University Medical Center at Princeton, Princeton, New Jersey 08540, USA. rbrolin@njbariatricspc.com
Abstract
BACKGROUND: No guidelines are available to assist surgeons in determining whether reversal is appropriate for patients with problematic bariatric operations. METHODS: A retrospective review of 2573 primary and 252 revisional bariatric operations was performed to determine the indications for the reversal of problematic bariatric operations. RESULTS: Of the 82 patients who had undergone reoperation for complications of the primary operation, 13 had undergone reversal rather than revision. Reversal was performed at the patient's request for 5 patients with intractable vomiting after banded restrictive operations and 2 patients with intractable diarrhea after jejunoileal bypass. The surgeon recommended reversal for the remaining 6 patients, including 3 with active substance abuse and 3 with severe metabolic complications. One postoperative complication (wound infection) occurred, with no deaths. CONCLUSION: The decision to reverse, rather than revise, a problematic bariatric operation is motivated by the perspective that the outcome of revision would also be problematic. Improved patient education and follow-up by the primary surgeon might have obviated the need for reversal in about one half of the patients in the present series.
BACKGROUND: No guidelines are available to assist surgeons in determining whether reversal is appropriate for patients with problematic bariatric operations. METHODS: A retrospective review of 2573 primary and 252 revisional bariatric operations was performed to determine the indications for the reversal of problematic bariatric operations. RESULTS: Of the 82 patients who had undergone reoperation for complications of the primary operation, 13 had undergone reversal rather than revision. Reversal was performed at the patient's request for 5 patients with intractable vomiting after banded restrictive operations and 2 patients with intractable diarrhea after jejunoileal bypass. The surgeon recommended reversal for the remaining 6 patients, including 3 with active substance abuse and 3 with severe metabolic complications. One postoperative complication (wound infection) occurred, with no deaths. CONCLUSION: The decision to reverse, rather than revise, a problematic bariatric operation is motivated by the perspective that the outcome of revision would also be problematic. Improved patient education and follow-up by the primary surgeon might have obviated the need for reversal in about one half of the patients in the present series.
Authors: Jeffrey I Mechanick; Adrienne Youdim; Daniel B Jones; W Timothy Garvey; Daniel L Hurley; M Molly McMahon; Leslie J Heinberg; Robert Kushner; Ted D Adams; Scott Shikora; John B Dixon; Stacy Brethauer Journal: Obesity (Silver Spring) Date: 2013-03 Impact factor: 5.002
Authors: Jeffrey I Mechanick; Adrienne Youdim; Daniel B Jones; W Timothy Garvey; Daniel L Hurley; M Molly McMahon; Leslie J Heinberg; Robert Kushner; Ted D Adams; Scott Shikora; John B Dixon; Stacy Brethauer Journal: Endocr Pract Date: 2013 Mar-Apr Impact factor: 3.443
Authors: Caroline E Sheppard; Erica L W Lester; Anderson W Chuck; Daniel W Birch; Shahzeer Karmali; Christopher J de Gara Journal: Gastroenterol Res Pract Date: 2013-12-26 Impact factor: 2.260