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SOS study

Revisional surgery more common after banding and VBG than GBP

Overall, the incidence rates were 40.7% in the banding subgroup, 28.3% in the VBG subgroup and 7.5% in the gastric bypass (GBP) subgroup

Patients who underwent gastric banding and vertical banded gastroplasty (VBG) have much higher rates of revisional surgery, according to the 26-year follow-up from the Swedish Obese Subjects (SOS) study. Overall, the incidence rates were 40.7% in the banding subgroup, 28.3% in the VBG subgroup and 7.5% in the gastric bypass (GBP) subgroup. The paper, ‘Reoperations After Bariatric Surgery in 26 Years of Follow-up of the Swedish Obese Subjects Study’, was published in JAMA Surgery, by researchers from the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Örebro University, Örebro, Sweden and the National Institute for Health and Welfare, Helsinki, Finland.

The authors noted that although bariatric surgery is an established treatment for obesity, knowledge and data on the long-term incidence of revisional surgery is rare, therefore they undertook the study to determine the incidence and type of revisional surgery after bariatric surgery in 26 years of follow-up of participants in the Swedish Obese Subjects (SOS) study. SOS study is a prospective non-randomised controlled study comparing bariatric surgery (banding, VBG and GBP) with usual care.

Swedish Obese Subjects

In total, 2,010 participants underwent surgery (376 participants underwent banding (18.7%); 1,365 had VBG (67.9%); and 266 had GBP (13.2%). During a median follow-up of 19 years, 559 participants (27.8%) underwent first-time revisional surgery, including 354 conversions to other bariatric procedures (17.6%), 114 corrective surgeries (5.6%) and 91 reversals to normal anatomy (4.5%). The researchers found that revisional surgeries (conversions, corrective surgery and reversals) were common after banding (153 of 376 [40.7%]) and VBG (386 of 1365 [28.3%]) but relatively rare after GBP (20 of 266 [7.5%]). Interestingly, patients who had banding and VBG mostly has a conversion to GBP or a reversal.

Incidence of reversals was five times higher after banding than after VBG (40.7% vs 7.5%; p<0.001). Corrective surgeries were equally common irrespective of the index surgery (72 of 1,365 patients who had VBG [5.3%]; 23 of 376 patients who had banding [6.1%]; 19 of 266 patients who had GBP [7.1%]). Revisional surgery indications, including inadequate weight loss, band-associated complications (migration, stenosis and slippage), staple-line disruptions and post-surgical morbidity, varied depending on index surgery subgroup. Most corrections occurred within the first ten years, whereas conversions and reversals occurred over the entire follow-up period.

For patients who had banding and underwent corrections, the weight loss before surgery was greater in those who underwent re-operation vs in those that were not (p<0.001). Weight trajectories until surgery in patients who underwent reversal were not significantly different from those that did not.

In the VBG subgroup, conversions, corrections, and reversals were performed in 275 (20.1%), 72 (5.3%), and 39 (2.8%) of 1,365 patients, respectively. Most corrections were carried out within eight to ten years of the index procedure, whereas conversions and reversals took place across the entire follow-up period.

In the subgroup who had GBP as the index procedure, conversions and corrections were performed in one patient (0.4%) and 19 patients (7.1%), respectively, with no reversals. As in the banding and VBG subgroups, corrections in the GBP subgroup were performed within ten years of the index procedure in 18 of 19 patients.

Interestingly, the outcomes suggest that complications and technical failures severe enough to necessitate revisional surgery are less common after ten-years, although, conversions and reversals in the banding and VBG groups were performed ten years after primary surgery – which the authors note could reflect dissatisfaction with the long-term weight outcomes such as weight regain.

“The main indications for revisional surgery in the banding and VBG subgroups were technical, morbidity associated, and weight associated, whereas bile reflux and esophagitis dominated in the patients who had GBP,” the authors conclude. “It is notable that revisional surgery after banding was in the long term even more common than revisions after VBG, which is nowadays abandoned. In conclusion, our data suggest that banding and VBG are inferior to GBP with regard to the need for revisional surgery overall.”

To access this paper, please click here

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