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Revision surgery after sleeve gastrectomy: a nationwide study with 10 years of follow-up.
Surg Obes Relat Dis. 2020 May 29 [Online ahead of print]SO

Abstract

BACKGROUND

Sleeve gastrectomy is the most common bariatric procedure worldwide. Several studies report good short- and midterm results. However, recent studies report alarming long-term outcomes, in particular about the revision rate.

OBJECTIVES

The aim of this study is the assessment of the revisional rate after sleeve gastrectomy and the analysis of most common reasons for surgical conversion and early complications.

SETTING

This study is based on a national claims database comprehensive of all bariatric procedures performed in a 10-year period.

METHODS

The French Programme De Médicalisation des Systèmes d'Information database was used to identify all patients who underwent sleeve gastrectomy between 2008 and 2018. Codes for diagnoses and procedures were used to describe the reason for and the morbidity of revision surgeries. Multivariate Cox proportional hazard regression analysis was performed to compare the risk of having a revision procedure.

RESULTS

During the analyzed period, a total of 224,718 sleeve gastrectomies were performed. The rate of revision surgery after sleeve gastrectomy was 4.7%, 7.5%, and 12.2%, at 5, 7, and 10 years post procedure, respectively. A history of gastric banding was associated with a higher risk of revision (hazard ratio, 2.81; 95% CI, 2.66-2.95; P < .001). The most common revision procedure was gastric bypass (75.2%), followed by resleeve (18.7%). The main reasons for revision surgery were persistence of obesity (87.0%) and gastroesophageal reflux disease (5.2%). After revision surgery, we observed the following complications: 5.1% gastric leak, 18% bleeding, and reoperation rate of 6.4%.

CONCLUSIONS

This study suggests that a large number of patients who initially underwent a sleeve gastrectomy will undergo a revisional surgery. This information should be considered in the initial choice of the bariatric procedure, and patients should be informed of the mid- and long-term risks.

Authors+Show Affiliations

Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France. Electronic address: andrea.lazzati@chicreteil.fr.Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France.Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France.Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France.Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France; Department of Pediatrics, Centre Hospitalier Intercommunal de Créteil, Créteil, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32636173

Citation

Lazzati, Andrea, et al. "Revision Surgery After Sleeve Gastrectomy: a Nationwide Study With 10 Years of Follow-up." Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 2020.
Lazzati A, Bechet S, Jouma S, et al. Revision surgery after sleeve gastrectomy: a nationwide study with 10 years of follow-up. Surg Obes Relat Dis. 2020.
Lazzati, A., Bechet, S., Jouma, S., Paolino, L., & Jung, C. (2020). Revision surgery after sleeve gastrectomy: a nationwide study with 10 years of follow-up. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery. https://doi.org/10.1016/j.soard.2020.05.021
Lazzati A, et al. Revision Surgery After Sleeve Gastrectomy: a Nationwide Study With 10 Years of Follow-up. Surg Obes Relat Dis. 2020 May 29; PubMed PMID: 32636173.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Revision surgery after sleeve gastrectomy: a nationwide study with 10 years of follow-up. AU - Lazzati,Andrea, AU - Bechet,Stéphane, AU - Jouma,Saadeddinne, AU - Paolino,Luca, AU - Jung,Camille, Y1 - 2020/05/29/ PY - 2020/02/24/received PY - 2020/04/24/revised PY - 2020/05/16/accepted PY - 2020/7/9/entrez KW - Bariatric surgery KW - Gastroesophageal reflux disease KW - Long-term results KW - Revisional surgery KW - Sleeve gastrectomy JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis N2 - BACKGROUND: Sleeve gastrectomy is the most common bariatric procedure worldwide. Several studies report good short- and midterm results. However, recent studies report alarming long-term outcomes, in particular about the revision rate. OBJECTIVES: The aim of this study is the assessment of the revisional rate after sleeve gastrectomy and the analysis of most common reasons for surgical conversion and early complications. SETTING: This study is based on a national claims database comprehensive of all bariatric procedures performed in a 10-year period. METHODS: The French Programme De Médicalisation des Systèmes d'Information database was used to identify all patients who underwent sleeve gastrectomy between 2008 and 2018. Codes for diagnoses and procedures were used to describe the reason for and the morbidity of revision surgeries. Multivariate Cox proportional hazard regression analysis was performed to compare the risk of having a revision procedure. RESULTS: During the analyzed period, a total of 224,718 sleeve gastrectomies were performed. The rate of revision surgery after sleeve gastrectomy was 4.7%, 7.5%, and 12.2%, at 5, 7, and 10 years post procedure, respectively. A history of gastric banding was associated with a higher risk of revision (hazard ratio, 2.81; 95% CI, 2.66-2.95; P < .001). The most common revision procedure was gastric bypass (75.2%), followed by resleeve (18.7%). The main reasons for revision surgery were persistence of obesity (87.0%) and gastroesophageal reflux disease (5.2%). After revision surgery, we observed the following complications: 5.1% gastric leak, 18% bleeding, and reoperation rate of 6.4%. CONCLUSIONS: This study suggests that a large number of patients who initially underwent a sleeve gastrectomy will undergo a revisional surgery. This information should be considered in the initial choice of the bariatric procedure, and patients should be informed of the mid- and long-term risks. SN - 1878-7533 UR - https://www.unboundmedicine.com/medline/citation/32636173/Revision_surgery_after_sleeve_gastrectomy:_a_nationwide_study_with_10 years_of_follow-up L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(20)30302-6 DB - PRIME DP - Unbound Medicine ER -
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