Bariatric Surgery Revision More Common After Banding, Vertical Banded Gastroplasty: Study

Individuals who undergo gastric banding or vertical banded gastroplasty (VGB) surgeries may be more likely to require some type of revision following the bariatric surgery, when compared to patients who had gastric bypass surgery, according to the findings of a new study. 

Swedish researchers found that the reasons for the bariatric surgery revisions varied, but most were necessary to convert to gastric bypass (GBP), correct problems, or reverse the process entirely. The findings were published January 2, in the journal JAMA Surgery.

Researchers used data from weight loss surgeries conducted at 25 public surgical departments in Sweden between 1987 and 2001, involving more than 2,000 patients in the Swedish Obese Subjects study. Patients were followed until December 2014, which included between 13 and 26 years of follow-up data for each patient.

One-quarter of the patients who underwent weight loss surgery needed some type of revision surgery later on. This included nearly 560 patients who had a first-time revisions surgery.

Bariatric surgery revisions included procedures done to correct problems or mistakes, reversals to put the patient back to their original anatomy, and conversions surgeries to convert patients from one type of weight loss surgery to another type. The need for a revision surgery included inadequate weight loss, band-associated complications, staple-line disruptions, and other problems.

Overall, 17 percent of patients converted to another bariatric procedure, six percent had corrective surgeries, and five percent had reversals.

Revisions following bariatric surgeries were the most common among patients who had banding surgeries. Roughly 40 percent of banding surgery patients needed a revision.

Similarly, 28 percent of vertical banded gastroplasty surgery patients needed a revision surgery. Comparatively, only seven percent of gastric bypass surgery patients required a revision. Reversal surgeries were five times higher among patients who had banding surgeries than among patients who had vertical banded gastroplasty surgeries.

Yet, patients who had banding and vertical banded gastroplasty and needed revision surgery mostly underwent conversions to gastric bypass, or had a full reversal restoring their original anatomy.

The rate of corrective surgeries among all patients was fairly equal at five to seven percent for all types of surgeries.

Most correction surgeries to fix a problem or error occurred within the first 10 years. However, conversion surgeries and reversals occurred over the entire follow-up period.

While many bariatric surgeries offer patients weight loss and in some cases improved health conditions, such as reversing diabetes, the surgeries also carry risks for the patients. One study linked gastric bypass surgery to an increased risk of complications, including death.

“It is notable that revisional surgery after banding was in the long term even more common than revisions after VBG, which is nowadays abandoned,” the researchers determined. “In conclusion, our data suggest that banding and VBG are inferior to GBP with regard to the need for revisional surgery overall.”