Comparison of primer and revisional laparoscopic mini-gastric bypass (MGB) for failed restrictive procedures: 2-year results at a tertiary center

Abstract

Aim: Revisional surgery is becoming a common and challenging practice in bariatric centers. The aim of this study was to evaluate laparoscopic mini-gastric bypass (MGB) as a revisional procedure for failed restrictive bariatric procedures. Material and Methods: One hundred sixty patients who underwent MGB between April 2012 and December 2017 were included in this retrospective study. Revisional MGB was defined as rMGB performed after failure of a first restrictive procedure. The main outcome measures were the success of therapeutic strategies, morbidity, body mass index (BMI), and percentage of excess BMI loss (%EBMIL) before and after revision. Results: Forty patients (25%) who had prior restrictive bariatric surgery (including 26 laparoscopic sleeve gastrectomies, 9 gastric plications, and 5 adjustable gastric bandings) underwent conversion to rMGB. Ninety patients (75%) underwent primary MGB (pMGB group). Both groups were comparable in age, gender, BMI, and preoperative co-morbidities. The pre-operative mean BMI of the rMGB group was 45.5 ± 7 kg/m2. No increase in morbidity was found between the 2 groups. Two patients with pMGB and one patient required conversion to RYGB after rMGB because of intractable biliary reflux. At 2 years, mean BMI was 30.5 kg/m2 and mean %EBMIL was 72% after rMGB; no significant differences were found compared with pMGB (BMI =29.5 kg/m2, %EBMIL =73%). Co-morbidities and remission rates were statically similar. Discussion: The results of our study show that rMGB is a safe and effective revisional procedure after failed restrictive bariatric surgery compared with pMGB.