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Original Investigation
January 2, 2019

Reoperations After Bariatric Surgery in 26 Years of Follow-up of the Swedish Obese Subjects Study

Author Affiliations
  • 1Institute of Medicine, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
  • 2Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
  • 3The Institute of Health and Care Sciences, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
  • 4Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
JAMA Surg. Published online January 2, 2019. doi:10.1001/jamasurg.2018.5084
Key Points

Question  What is the long-term incidence of bariatric reoperations in patients who undergo bariatric surgery for morbid obesity?

Findings  In this analysis of 2010 patients in the Swedish Obese Subjects study cohort, first-time revisional surgery (conversions, corrections, and reversals) were common after banding operations (40.7%) and vertical banded gastroplasty (28.3%) but relatively rare (7.5%) after gastric bypass operations. Patients who had banding and vertical banded gastroplasty primarily underwent conversion to gastric bypass or reversal, and corrections were equally common (5.3%-7.1%) irrespective of index surgery, but indications differed between groups.

Meaning  Revisional surgery is more common after banding and vertical banded gastroplasty than after gastric bypass, involving a higher incidence of conversions and reversals.

Abstract

Importance  Bariatric surgery is an established treatment for obesity, but knowledge on the long-term incidence of revisional surgery is scarce.

Objective  To determine the incidence and type of revisional surgery after bariatric surgery in 26 years of follow-up of participants in the Swedish Obese Subjects (SOS) study.

Design, Setting, and Participants  The SOS study is a prospective nonrandomized controlled study comparing bariatric surgery (banding, vertical banded gastroplasty [VBG], and gastric bypass [GBP]) with usual care. The bariatric surgeries in the SOS study were conducted at 25 public surgical departments in Sweden. Men with body mass index values of 34 or higher and women with body mass indexes of 38 or higher were recruited to the surgery group of the SOS study between September 1, 1987, and January 31, 2001, and follow-up continued until December 31, 2014. Data analysis occurred from November 2016 to April 2018.

Interventions  Banding, VBG, or GBP.

Main Outcomes and Measures  Revisional surgeries, analyzed using data from questionnaires, hospital records, and the Swedish National Patient register through December 31, 2014.

Results  A total of 2010 participants underwent surgery. The age range was 37 to 60 years. A total of 376 participants underwent banding (18.7%), while 1365 had VBG (67.9%) and 266 had GBP (13.2%). During a median follow-up of 19 years, 559 participants (27.8%) underwent first-time revisional surgery, including 354 conversions to other bariatric procedures (17.6%), 114 corrective surgeries (5.6%), and 91 reversals to normal anatomy (4.5%). Revisional surgeries (conversions, corrective surgery, and reversals) were common after banding (153 of 376 [40.7%]) and VBG (386 of 1365 [28.3%]) but relatively rare after GBP (20 of 266 [7.5%]). Patients who had banding and VBG primarily underwent conversions to GBP or reversals. Incidence of reversals was 5 times higher after banding than after VBG (40.7% vs 7.5%; unadjusted hazard ratio, 5.19 [95% CI, 3.43-7.87]; P < .001). Corrective surgeries were equally common irrespective of the index surgery (72 of 1365 patients who had VBG [5.3%]; 23 of 376 patients who had banding [6.1%]; 19 of 266 patients who had GBP [7.1%]). Revisional surgery indications, including inadequate weight loss, band-associated complications (migration, stenosis, and slippage), staple-line disruptions, and postsurgical morbidity, varied depending on index surgery subgroup. Most corrections occurred within the first 10 years, whereas conversions and reversals occurred over the entire follow-up period.

Conclusions and Relevance  Corrective surgeries occur mainly within the first 10 years and with similar incidences across all 3 surgical subgroups, but indications varied. Conversions (mainly to GBP) and reversals occurred after many years and were most frequent after banding and VBG, reflecting a higher overall revisional surgery demand after these operations.

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