Background:
The aim was to review individuals undergoing a third bariatric procedure within a single institution and identify common indications for doing so. Multiple or subsequent procedures are becoming more common and individuals seeking further surgical intervention for various issues is also increasing.
Methods:
A prospective bariatric database was analysed to review all patients who had undergone gastric banding, conversion to sleeve gastrectomy followed by a further conversion to gastric bypass. Presenting reasons and symptoms were looked at as well as their weight progress and complication rate.
Results:
A total of 26 individuals within this centre underwent gastric bypass as a revisional procedure after sleeve gastrectomy, the first subsequent procedure after gastric banding (the primary procedure). Most individuals were referred from other centres for their third separate procedure. Reasons for seeking removal of gastric band and progression to sleeve were lack of weight loss, vomiting, reflux, food intolerance, eroded or slipped band. A combination of symptoms was common. Median time frame between surgeries was 4 years. Reasons for progressing from sleeve to gastric bypass included weight regain, reflux, stricture, inadequate restriction, and anatomical issues such as large or dilated fundus. Time frame between second and third procedure was 2 years. Median BMI at primary procedure was 47kgm2, 43 at time of sleeve and 41 at time of bypass. There is a 50% early complication rate after the final conversion to gastric bypass, compared with 28% for band to bypass and 31% for sleeve to bypass procedure.
Conclusion:
It is safe to say that individuals seeking a third procedure are experiencing multiple symptoms and halted weight loss. Conversion surgeries are only undertaken when all other options such as diet and behaviour modification are exhausted. Endoscopic procedures to address symptoms and lack of weight loss should also be considered.