Daniel Gero1, Marie Vannijvel, Sietske Okkema, Ellen Deleus, Aaron Lloyd, Emanuele Lo Menzo, George Tadros, Ivana Raguz, Andres San Martin, Marko Kraljević, Styliani Mantziari, Sebastien Frey, Lisa Gensthaler, Henna Sammalkorpi, José Luis Garcia-Galocha, Amalia Zapata, Talar Tatarian, Tom Wiggins, Ekhlas Bardisi, Jean-Philippe Goreux, Yosuke Seki, René Vonlanthen, Jeannette Widmer, Andreas Thalheimer, Kazunori Kasama, Jacques Himpens, Marianne Hollyman, Richard Welbourn, Rajesh Aggarwal, Alec Beekley, Matias Sepulveda, Antonio Torres, Anne Juuti, Paulina Salminen, Gerhard Prager, Antonio Iannelli, Michel Suter, Ralph Peterli, Camilo Boza, Raul Rosenthal, Kelvin Higa, Matthias Lannoo, Eric J Hazebroek, Bruno Dillemans, Pierre-Alain Clavien, Milo Puhan, Dimitri A Raptis, Marco Bueter. 1. Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland Department of General Surgery, AZ Sint Jan Brugge-Oostende, Bruges, Belgium Department of Surgery, Rijnstate Hospital/Vitalys Clinics, Arnhem, The Netherlands Department of General Surgery, University Hospital Leuven, Leuven, Belgium Minimally Invasive and Bariatric Surgery, Fresno Heart and Surgical Hospital, Fresno, CA, USA The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL, USA Bariatric and Metabolic Center, Department of Surgery, Clinica Las Condes, Las Condes, Santiago, Chile Department of Visceral Surgery, Clarunis: St.Clara Hosptital, Basel, Switzerland Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland Digestive Surgery and Liver Transplantation Unit, University Hospital Nice, University Côte d'Azur, Nice, France Department of Surgery, Medical University of Vienna, Vienna, Austria Department ofGastroenterological Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland Department of Surgery, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain Bariatric and Metabolic Surgery Center, Dipreca Hospital, Las Condes, Santiago, Chile Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK Department of Surgery, St Blasius Hospital, Dendermonde, Belgium Department of Surgery, Delta CHIREC Hospital, Brussels, Belgium Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan The European School of Laparoscopic Surgery, St Pierre University Hospital, Brussels, Belgium Department of Surgery, University of Turku, Turku, Finland Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland Department of Clinical Research, University of Basel, Basel, Switzerland Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland Department of Hepatobiliary and Pancreas Surgery and Liver Transplantation, Royal Free Hospital, London, UK.
Abstract
OBJECTIVE: To define "best possible" outcomes for secondary bariatric surgery (BS). BACKGROUND: Management of poor response and of long-term complications after BS is complex and under-investigated. Indications and types of reoperations vary widely and postoperative complication rates are higher compared to primary BS. METHODS: Out of 44,884 BS performed in 18 high-volume centers from 4 continents between 06/2013-05/2019, 5,349 (12%) secondary BS cases were identified. Twenty-one outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of centers. Benchmark cases had no previous laparotomy, diabetes, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, thromboembolic events, BMI> 50 kg/m2 or age> 65 years. RESULTS: The benchmark cohort included 3143 cases, mainly females (85%), aged 43.8 ± 10 years, 8.4 ± 5.3 years after primary BS, with a BMI 35.2 ± 7 kg/m2. Main indications were insufficient weight loss (43%) and gastro-esophageal reflux disease/dysphagia (25%). 90-days postoperatively, 14.6% of benchmark patients presented ≥1 complication, mortality was 0.06% (n = 2). Significantly higher morbidity was observed in non-benchmark cases (OR 1.37) and after conversional/reversal or revisional procedures with gastrointestinal suture/stapling (OR 1.84). Benchmark cutoffs for conversional BS were ≤4.5% re-intervention, ≤8.3% re-operation 90-days postoperatively. At 2-years (IQR 1-3) 15.6% of benchmark patients required a reoperation. CONCLUSION: Secondary BS is safe, although postoperative morbidity exceeds the established benchmarks for primary BS. The excess morbidity is due to an increased risk of gastrointestinal leakage and higher need for intensive care. The considerable rate of tertiary BS warrants expertise and future research to optimize the management of non-success after BS.
OBJECTIVE: To define "best possible" outcomes for secondary bariatric surgery (BS). BACKGROUND: Management of poor response and of long-term complications after BS is complex and under-investigated. Indications and types of reoperations vary widely and postoperative complication rates are higher compared to primary BS. METHODS: Out of 44,884 BS performed in 18 high-volume centers from 4 continents between 06/2013-05/2019, 5,349 (12%) secondary BS cases were identified. Twenty-one outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of centers. Benchmark cases had no previous laparotomy, diabetes, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, thromboembolic events, BMI> 50 kg/m2 or age> 65 years. RESULTS: The benchmark cohort included 3143 cases, mainly females (85%), aged 43.8 ± 10 years, 8.4 ± 5.3 years after primary BS, with a BMI 35.2 ± 7 kg/m2. Main indications were insufficient weight loss (43%) and gastro-esophageal reflux disease/dysphagia (25%). 90-days postoperatively, 14.6% of benchmark patients presented ≥1 complication, mortality was 0.06% (n = 2). Significantly higher morbidity was observed in non-benchmark cases (OR 1.37) and after conversional/reversal or revisional procedures with gastrointestinal suture/stapling (OR 1.84). Benchmark cutoffs for conversional BS were ≤4.5% re-intervention, ≤8.3% re-operation 90-days postoperatively. At 2-years (IQR 1-3) 15.6% of benchmark patients required a reoperation. CONCLUSION: Secondary BS is safe, although postoperative morbidity exceeds the established benchmarks for primary BS. The excess morbidity is due to an increased risk of gastrointestinal leakage and higher need for intensive care. The considerable rate of tertiary BS warrants expertise and future research to optimize the management of non-success after BS.
Authors: Aiman Ismaeil; Daniel Gero; Christina N Boyle; Daniela Alceste; Osama Taha; Alan C Spector; Thomas A Lutz; Marco Bueter Journal: Front Nutr Date: 2022-04-13