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Third bariatric procedure for insufficient weight loss or weight regain: how far should we go?

Abstract : BACKGROUND: Revisional procedures in bariatric surgery are increasing with several debated failure risk factors, such as super obesity and old age. No study has yet evaluated the outcomes and risks of a third bariatric procedure indicated for weight loss failure or weight regain. OBJECTIVES: To assess failure risks of a third bariatric procedure according to Reinhold's criteria (percentage excess weight loss [%EWL] ≤50% and/or body mass index [BMI] ≥35 kg/m(2)). SETTING: A university-affiliated tertiary care center, France. METHODS: From 2009 to 2019, clinical data and weight loss results of patients who benefited from 3 bariatric procedures for weight loss failure or weight regain were collected prospectively and analyzed using a binary logistic regression. Weight loss failure was defined according to Reinhold's criteria. RESULTS: Among 1401 bariatric procedures performed, 336 patients benefited from 2 or more procedures, and 45 had a third surgery. Eleven patients that were reoperated on because of malnutrition or gastroesophageal reflux disease were excluded from the final analysis. Among 34 patients with 3 procedures because of weight loss failure or regain, mean BMI was 48.3 ± 8.3 kg/m(2), and mean age was 30 ± 10.7 years. Three out of 34 patients (9%) presented a severe complication (Dindo-Clavien IIIb) and 2 (6%) had a minor one. Achieving Reinhold's weight loss criteria after the second bariatric procedure was a significant predictor of success of the third procedure (β = 2.9 ± 1.3 S.E.). CONCLUSION: Not reaching Reinhold's criteria after a second bariatric procedure was identified as a significant risk factor of failure of a third procedure. A third surgery should be carefully discussed especially in case of primary failure of previous procedures.
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https://www.hal.inserm.fr/inserm-03274431
Contributor : Laboratoire Carmen <>
Submitted on : Wednesday, June 30, 2021 - 9:55:28 AM
Last modification on : Friday, July 2, 2021 - 3:31:52 AM

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T. Lunel, S. Iceta, A. Pasquer, E. Pelascini, J. Perinel, et al.. Third bariatric procedure for insufficient weight loss or weight regain: how far should we go?. Surgery for Obesity and Related Diseases, Elsevier, 2021, 17 (1), pp.96-103. ⟨10.1016/j.soard.2020.08.032⟩. ⟨inserm-03274431⟩

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