Case-matched analysis comparing outcomes of revisional versus primary laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most common approaches used to revise post-bariatric patients with inadequate weight loss or significant weight regain. Previous studies have analyzed the outcomes of open revisional RYGB versus primary RYGB, but no case-control matched analysis comparing revisional LRYGB versus primary LRYGB has been performed.
METHODS: Our cohort includes 37 consecutive patients who underwent revisional LRYGB because of unsatisfactory weight loss or weight regain matched in a 1:2 ratio with 74 control patients who underwent primary LRYGB. Matching included the following parameters: age, gender, preoperative body mass index and comorbidities (diabetes, obstructive sleep apnea, and hypertension).
RESULTS: The revisional group had longer length of stay compared with the primary group (3.8 vs. 2.4 days, P = 0.02) and a higher conversion to laparotomy rate (10.8 vs. 0 %, P = 0.01). The revisional group had a higher 30-day morbidity compared with the primary group (27 vs. 8.1 %, P = 0.02). There were no deaths in both groups. The two groups had similar 30-day readmission and 30 day reoperation rates. At 3, 6, and 12 months of follow-up, the revisional LRYGB group had significantly lower percent of excess weight loss (EWL) than the primary LRYGB group (3 months, 30 vs. 38.4, P = 0.001; 6 months, 36.3 vs. 52.9, P = 0.001; 12 months, 46.5 vs. 68.2, P = 0.001).
CONCLUSIONS: Revisional LRYGB is characterized by lower EWL and higher morbidity than primary LRYGB. However, our data suggest that revisional LRYGB is still capable of providing significant weight loss in these high-risk patients.