An Introduction To Revisional Bariatric Procedures - Options, Challenges And Outcomes | 59480
Journal of Gastrointestinal & Digestive System
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Introduction: Bariatric and metabolic surgery is now well established in tackling the pandemic of obesity and its complications.
Although it’s safe, its long term issues such as weight recidivism, co-morbidity resolution and complications needs to be
addressed. Therefore, revisional surgeries are on the rise. There are many reasons a revision is required and our series attempts
to illustrate the complexities involved, options available and the challenges faced.
Methods: A total of 20 revisional procedures were performed at General Hospital Taiping over a period of 18 months by a
single surgeon. Patient Demographics, indications for revision, type of initial and revisional intervention, duration of surgery,
postoperative morbidity, 30-day readmissions and re-surgeries were reviewed prospectively and retrospectively.
Findings: Following, revisions were performed for the below mentioned primary surgeries – LAGB (5): 1 REMOVAL, 1
to LSG, 3 to RYGB; LSG (8): 1 RESLEEVE, 3 to MGB/OAGB, 4 to RYGB; MGB/OAGB (1): 1 to RYGB and RYGB (6): 1
REVISION of RYGB (resizing the pouch & distalization of Jejuno jejunostomy), 1 to NORMAL ANATOMY, 2 proximilization
of Jejuno jejunostomy, 2 RE-DO of Jejuno jejunostomy. Morbidity - All patients’ had longer hospital stay compared to primary
interventions. 2 patients were re-2 RE-DO of Jejuno jejunostomy operated within 48 hrs. & 1 at 14 days post op. All achieved
significant % EWL except 1.
Conclusion: Revisional surgeries are effective but complex procedures. They can be performed safely and mortalities can
be avoided in hands of high volume experienced surgeons. Complication rates are higher than primary bariatric surgery.
Choosing the correct revisional procedure is of paramount importance.
C. Rajkumar Vinayak is a consultant general and bariatric surgeon at General Hospital Taiping, Malaysia. He completed his M.B.B.S (Jipmer, India) in 1996 and M.S. (Gen. Surg.– Osmania University, India) in 2002. He achieved his FIAGES and then went on to complete his fellowship in Advanced Lap. & Bariatric Surgery from L.O.C. Pune, India. He started Bariatric services in Northern Malaysia since 2007. He performs a wide range of bariatric surgeries including SILS sleeve gastrectomies and revisional procedures & has pioneered stapleless bariatric surgery in Malaysia. His stapleless LSG technique has been published internationally & been approved by Medical Research & Ethics Council (MREC), Malaysia. Active in research involving the research council UK (RCUK) & Univ.Malaya (Malaysia), he was also recently invited as a faculty speaker at the 6th global gastroenterology conference in Birmingham UK, APMBSS, CSSAM, MYMBS & MUGIS - 2016. He has successfully started the bariatric training programme for Univ. Sains malaysia in 2016.