Title: Initial results of reoperative bariatric surgery: a retrospective feasibility and safety study at a low-volume unit

Background This study assessed the feasibility and results of revisional bariatric surgery at a low-volume unit.Methods This retrospective study was conducted from January 2017 to August 2020; the revision group comprised patients treated for weight regain (WR, n = 6), insufficient weight loss (IWL, n =3), and various complications (n=6). Clinical characteristics and 30-day outcomes were assessed and compared with those of primary bariatric procedures (control, n=173). Results A total of 8.0% (15/188) of patients underwent revisional procedures and tended to be elderly (40.1 vs. 38.2 years), be female (73.3% vs. 54.9%), and have a significantly lower body mass index (33.1 vs. 39.9 kg/m2) and fewer comorbidities than controls. Gastric bypass was the most prevalent revisional procedure. A significantly longer operative duration (155 and 96 min; p < 0.001), longer length of stay (3.7 and 2.4 days) and higher 30-day complication rate (20.0% vs. 4.6%) were found in the revision group, including one case of leakage and another of jejunojejunostomy obstruction. There were no cases of conversion to open surgery or mortality. A total of 5/6 WR patients achieved excessive weight loss >50%, versus only one IWL patient who reached this goal. Complications, including marginal ulcer, fistula and post-sleeve gastrectomy stenosis, were alleviated after revision.Conclusion Revisional surgery appears to be feasible and effective in a low-volume practice in patients with WR and complications after primary bariatric procedures; however, the benefits should be weighed against the risks. More robust evidence is required to support ongoing practice.