Effect of primary versus revisional Roux-en-Y gastric bypass: inferior weight loss of revisional surgery after gastric banding

Background: Laparoscopic adjustable gastric banding is a popular and effective restrictive bariatric procedure. However, with longer follow-up, it has become clear that a considerable number of patients require revisional surgery, of which Roux-en-Y gastric bypass (RYGB) is the most commonly performed procedure. Studies that compared the outcomes of primary RYGB and revisional RYGB have not been conclusive. Our objective was to determine whether significant differences exist in the 1-year outcomes between primary RYGB (prim-RYGB) and revisional RYGB after laparoscopic adjustable gastric banding (rev-RYGB) at a major training hospital in The Netherlands. Methods: All prim-RYGB and rev-RYGB procedures performed from 2007 to 2009 were analyzed. Data were collected regarding weight loss, hospitalization, operative time, postoperative complications, and co-morbidities. Results: A total of 292 RYGB procedures were performed: 66 rev-RYGB and 226 prirn-RYGB procedures. The operative time was significantly shorter in the prim-RYGB group (136.6 +/- 37.5 versus 167.5 +/- 40.6 min; P < .0001). No significant differences were found in hospitalization time (4.4 +/- 1.7 versus 4.9 +/- 2.4 d; P = .063) or complication rate (14.7% versus 15.2%; P = .962). No deaths occurred in either group. The number of patients with resolved diabetes and hypertension did not differ between the 2 groups (50.1% versus 23.1%; P = .116; and 40.7% versus 25.0%; P = .384, respectively). Weight loss was significantly greater in the prim-RYGB group in terms of excess weight loss (71.6% +/- 20.8% versus 48.4% +/- 26.8%; P < .0001), body mass index reduction (13.0 +/- 3.8 versus 10.2 +/- 5.6 kg/m(2); P < .0001), absolute weight loss (37.4 +/- 11.5 versus 29.3 +/- 17.2 kg; P = .001), and percentage of weight loss (29.7% +/- 8% versus 21.7% +/- 11.5%; P < .0001). Conclusion: rev-RYGB is a safe procedure with outcomes similar to those of prim-RYGB in terms of complication rate, hospitalization time, and effect on co-morbidity. Weight loss, however, was significantly less after rev-RYGB than after prim-RYGB. (Surg Obes Relat Dis 2013;9:253-259.) (C) 2013 American Society for Metabolic and Bariatric Surgery. All rights reserved.