Trends and safety of bariatric revisional surgery in Italy: multicenter, prospective, observational study

Cristian E Boru; Giuseppe M Marinari; Stefano Olmi; Paolo Gentileschi; Mario Morino; Marco Anselmino; Mirto Foletto; Paolo Bernante; Luigi Piazza; Nicola Perrotta; Riccardo Morganti; Gianfranco Silecchia; Cooperative RESTART Group

doi:10.1016/j.soard.2023.05.009

Trends and safety of bariatric revisional surgery in Italy: multicenter, prospective, observational study

Surg Obes Relat Dis. 2023 Nov;19(11):1270-1280. doi: 10.1016/j.soard.2023.05.009. Epub 2023 May 23.

Collaborators

Cooperative RESTART Group:
Alberto Di Biasio, Manuela Trotta, Francesco Di Capua, Emanuela Bianciardi, Michela Campanelli, Bruno Sensi, Simone Arolfo, Antonio Salzano, Alberto Oldani, Rudj Mancini, Luigi Fiorello, Emanuela Filippone, Matteo Rottoli, Gastone Veroux, Marta Celiento

Affiliations

¹ General Surgery Division, Department of Medical Surgical Sciences and Biotechnologies and Department of Medical Surgical Sciences and Translational Medicine, University "La Sapienza" of Rome, Rome, Italy. Electronic address: cristian.boru@uniroma1.it.
² Bariatric Unit, Humanitas Clinical and Research Hospital, IRCCS Rozzano, Milan, Italy.
³ General and Oncological Surgery Department, Center of Bariatric Surgery, Policlinico San Marco di Zingonia, Bergamo, Italy.
⁴ Bariatric and Metabolic Surgery Department, San Carlo of Nancy Hospital and "Tor Vergata" University of Rome, Rome, Italy.
⁵ General Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy.
⁶ IRCCS San Raffaele Hospital, Milan, Italy.
⁷ Bariatric Surgery Unit, Azienda Ospedaliera of University of Padova, Padova, Italy.
⁸ Metabolic and Obesity Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Centre for the Study and Research of Treatment for Morbid Obesity, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
⁹ General Surgery and Emergency Department, ARNAS Garibaldi Nesima Hospital, Catania, Italy.
¹⁰ General Surgery Department, Villa d'Agri Hospital, Potenza, Italy.
¹¹ Section of Statistics, University Hospital of Pisa, Pisa, Italy.
¹² General Surgery Division, Department of Medical Surgical Sciences and Biotechnologies and Department of Medical Surgical Sciences and Translational Medicine, University "La Sapienza" of Rome, Rome, Italy.

PMID: 37391349
DOI: 10.1016/j.soard.2023.05.009

Abstract

Background: Revisional bariatric surgery (RBS) represents a further solution for patients who experience inadequate weight loss (IWL) following primary bariatric surgery (BS) or significant weight regain (WR) following initial satisfactory response. RBS guidelines are lacking; however, an increased trend in further BS offerings has been reported recently.

Objective: Analyze trend, mortality, complication, readmission, and reoperation rates for any reason at 30 days after RBS in Italy.

Setting: Ten Italian high-volume BS centers (university hospitals and private centers).

Methods: Prospective, observational, multicenter study enrolling patients undergoing RBS between October 1, 2021, and March 31, 2022, registering reasons for RBS, technique, mortality, intraoperative and perioperative complications, readmissions, and reinterventions for any reason. Patients undergoing RBS during the same calendar interval in 2016-2020 were considered control patients.

Results: A total of 220 patients were enrolled and compared with 560 control-group patients. Mortality was .45% versus .35% (n.s), with an overall mortality of .25%, while open surgery or conversion to open surgery was registered in 1%. No difference was found for mortality, morbidity, complications, readmission (1.3%), and reoperation rates (2.2%). IWL/WR was the most frequent cause, followed by gastroesophageal reflux disease; Roux-en-Y gastric bypass was the most used revisional procedure (56%). Sleeve gastrectomy was the most revised procedure in the study group, while gastric banding was the most revised in the control group. RBS represents up to 9% of the total BS in the Italian participating centers.

Conclusions: Laparoscopy represents the standard approach for RBS, which appears safe. Current Italian trends show a shift toward sleeve gastrectomy being the most revised procedure and Roux-en-Y gastric bypass being the most frequent revisional procedure.

Keywords: Conversion; Perioperative morbidity and mortality; Readmission; Reoperation; Revisional bariatric surgery; Trends.