May 16, 2022

Postoperative morbidity and weight loss after revisional bariatric surgery for primary failed restrictive procedure: A systematic review and network meta-analysis

ACAndréa ChiericiCentre National de la Recherche Scientifique NCNicolas ChevalierInserm AIAntonio IannelliBetsi Cadwaladr University Health Board

Structured PICO

Which revisional bariatric procedure performs best in terms of weight loss and morbidity after failure of primary restrictive surgery?

Population

Patients undergoing revisional bariatric surgery after failure of primary restrictive surgery (vertical banded gastroplasty, laparoscopic adjusted gastric banding, and sleeve gastrectomy) across 39 studies.

Intervention

Revisional bariatric procedures including biliopancreatic diversion with duodenal switch, single-anastomosis duodenoileal bypass, one-anastomosis gastric bypass, and Roux-en-Y gastric bypass.

Comparator

Re-sleeve gastrectomy.

Outcome

Weight loss (1 and 3-years % total weight loss) and postoperative morbidity.surrogate

Single-anastomosis duodenoileal bypass and one-anastomosis gastric bypass appear to be the optimal revisional procedures after failed restrictive bariatric surgery, balancing effective weight loss with lower morbidity.

Abstract

BACKGROUND: revisional bariatric surgery is gaining increasing interest as long term follow-up studies demonstrate an elevated failure rate of primary surgery due to insufficient weight loss, weight regain or complications. This particularly concerns restrictive bariatric surgery which has been widely adopted from the '80s till present through different procedures, notably vertical banded gastroplasty, laparoscopic adjusted gastric banding and sleeve gastrectomy. The aim of this study is to define which revisional bariatric procedure performs the best after failure of primary restrictive surgery. METHODS: a systematic review and network meta-analysis of 39 studies was conducted following the PRISMA guidelines and the Cochrane protocol. RESULTS: biliopancreatic diversion with duodenal switch guarantees the best results in terms of weight loss (1 and 3-years %TWL MD: 12.38 and 28.42) followed by single-anastomosis duodenoileal bypass (9.24 and 19.13), one-anastomosis gastric bypass (7.16 and 13.1), and Roux-en-Y gastric bypass (4.68 and 7.3) compared to re-sleeve gastrectomy. Duodenal switch and Roux-en-Y gastric bypass are associated to an increased risk of late major morbidity (OR: 3.07 and 2.11 respectively) compared to re-sleeve gastrectomy while no significant difference was highlighted for the other procedures. Re-sleeve gastrectomy is the revisional intervention most frequently burdened by weight recidivism; compared to it, patients undergoing single-anastomosis duodenoileal bypass have the lowest risk of weight regain (OR: 0.07). CONCLUSION: considering the analyzed outcomes altogether, single-anastomosis duodenoileal bypass and one-anastomosis gastric bypass are the most performing revisional procedures after failure of restrictive surgery due to satisfying short and mid-term weight loss and low early and late morbidity. Moreover, single-anastomosis duodenoileal bypass has low risk of weight recidivism.

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