Safety and long term efficacy of revisional surgery in severe obesity

BACKGROUND: A National Institutes of Health Consensus Conference in 1991 established gastric surgery as accepted therapy for the treatment of severe obesity. The increasing prevalence of obesity in the United States, and the increasing numbers of patients undergoing gastric surgery for severe obesity, result in substantial numbers of patients being considered for revisional surgery. The indications and efficacy of revisional surgery remain controversial. METHODS: Sixty-three patients were followed prospectively after undergoing revisional surgery for obesity between 1981 and 1994. All patients had previously undergone obesity operations. Weight data were recorded at the time of original obesity surgery, at revisional surgery, and at most current follow-up. Complications following revisional surgery were monitored. RESULTS: The follow-up in the group is 98%. Revisional surgery after obesity surgery was associated with a 0% mortality rate and a serious complication rate of 16%. Body mass index (BMI) at the time of original surgery was 50 +/- 10 kg/m(2), at revisional surgery 39 + 9 kg/m(2), and at recent follow-up 34 +/- 10 kg/m(2) (P (0.001 vs original BMI). Those patients whose original BMI was >50 kg/m2 lost significantly more weight (P <0.0001) than those with an original BMI <50 kg/m(2). CONCLUSIONS: Revisional gastric surgery is safe and does provide patients with the opportunity to achieve long-term weight control.