15 February, 2010
Repeat weight–loss surgery carries a higher risk of complications than the initial surgical procedure, new research has found.
The surgical treatment, known as bariatric surgery, is the only effective method for long–term weight loss in severely obese people. Rates of repeat bariatric surgery are reported to range from 5 percent to 56 percent, according to background information in the new study.
In their report, Greek researchers looked at 56 patients who had repeat bariatric surgery between 1995 and 2008. The patients had an average age of 39.6, and an average body mass index (BMI) of 46.9. (BMI is a measurement that takes into account weight and height, and those with a BMI over 30 are considered obese.)
The three main reasons for the “revisional” bariatric surgery were: unsatisfactory weight loss after the initial procedure; severe nutritional complications such as protein malnutrition; and intolerable side effects such as blocking or narrowing of the digestive tract.
The patients were followed–up for an average of 102 months after their revisional surgery. None of them died, but 19 (33.9 percent) had serious complications within one to three months after surgery, including internal leakage from the surgical site, acute kidney failure and pneumonia.
Late complications, which are those that occurred more than 90 days after surgery, were reported in 13 patients (23.2 percent). These complications included hernia at the incision site and narrowing of the passageway between the stomach and intestine, the study authors noted.
The 39 patients who had revisional surgery due to inadequate weight loss after their initial procedure achieved a significant decline in BMI, from an average of 55.4 to an average of 35, with an average loss of nearly 69 percent of excess body weight. The revisional surgery also benefited those who experienced nutritional complications and intolerable side effects after their initial procedure, according to the study published in the February issue of the journal Archives of Surgery.
“The accelerated growth of bariatric surgery during the last decade has led to a proportional increase of bariatric revisions worldwide. As improvements in technique and instrumentation take place in this surgical field, along with the novel compelling application of bariatric surgery in the treatment of severe metabolic disorders, it is very likely that revision rates of both failed operations of the past and currently popular procedures will increase considerably in the near future,” concluded the researchers at the University Hospital of Patras in Rion, Greece.
“New concepts and improved techniques by well–trained surgeons in properly organized institutions coupled with cautious patient selection represent the cornerstone for achieving favorable results and for extending patients' longevity,” the researchers added.
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