Revisional bariatric surgery for gastroesophageal reflux disease: characterizing patient and procedural factors and 30-day outcomes for a retrospective cohort of 4412 patients
Introduction Gastroesophageal reflux disease (GERD) is a well-established potential consequence of bariatric surgery and can require revisional surgery. Our understanding of the population requiring revision is limited. In this study, we aim to characterize patients requiring revisional surgery for...
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| Veröffentlicht in: | Surgical endoscopy 2024, Vol.38 (1), p.75-84 |
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| creator | MacVicar, Sarah Mocanu, Valentin Jogiat, Uzair Verhoeff, Kevin Dang, Jerry Birch, Daniel Karmali, Shahzeer Switzer, Noah |
| description | Introduction
Gastroesophageal reflux disease (GERD) is a well-established potential consequence of bariatric surgery and can require revisional surgery. Our understanding of the population requiring revision is limited. In this study, we aim to characterize patients requiring revisional surgery for GERD to understand their perioperative risks and identify strategies to improve their outcomes.
Methods
Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) registry, a retrospective cohort of patients who required revisional surgery for GERD in 2020 was identified. Multivariable logistic regression modelling was used to assess correlations between baseline characteristics and morbidity.
Results
4412 patients required revisional surgery for GERD, encompassing 24% of all conversion procedures. In most cases, patients underwent sleeve gastrectomy (SG) as their original surgery (
n
= 3535, 80.1%). The revisional surgery for most patients was a Roux-en-Y gastric bypass (RYGB) (
n
= 3722, 84.4%). Major complications occurred in 527 patients (11.9%) and 10 patients (0.23%) died within 30 days of revisional surgery. Major complications included anastomotic leak in 31 patients (0.70%) and gastrointestinal bleeding in 38 patients (0.86%). Multivariable analyses revealed that operative length, pre-operative antacid use, and RYGB were predictors of major complications.
Conclusion
GERD is the second most common indication for revisional surgery in patients who have undergone bariatric surgery. Patients who underwent SG as their initial procedure were the primary group who required revisional surgery for GERD; most underwent revision via RYGB. Further inquiry is needed to tailor operative approaches and pre-operative optimization for revisional surgery patients.
Graphical abstract |
| doi_str_mv | 10.1007/s00464-023-10500-4 |
| format | Article |
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Gastroesophageal reflux disease (GERD) is a well-established potential consequence of bariatric surgery and can require revisional surgery. Our understanding of the population requiring revision is limited. In this study, we aim to characterize patients requiring revisional surgery for GERD to understand their perioperative risks and identify strategies to improve their outcomes.
Methods
Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) registry, a retrospective cohort of patients who required revisional surgery for GERD in 2020 was identified. Multivariable logistic regression modelling was used to assess correlations between baseline characteristics and morbidity.
Results
4412 patients required revisional surgery for GERD, encompassing 24% of all conversion procedures. In most cases, patients underwent sleeve gastrectomy (SG) as their original surgery (
n
= 3535, 80.1%). The revisional surgery for most patients was a Roux-en-Y gastric bypass (RYGB) (
n
= 3722, 84.4%). Major complications occurred in 527 patients (11.9%) and 10 patients (0.23%) died within 30 days of revisional surgery. Major complications included anastomotic leak in 31 patients (0.70%) and gastrointestinal bleeding in 38 patients (0.86%). Multivariable analyses revealed that operative length, pre-operative antacid use, and RYGB were predictors of major complications.
Conclusion
GERD is the second most common indication for revisional surgery in patients who have undergone bariatric surgery. Patients who underwent SG as their initial procedure were the primary group who required revisional surgery for GERD; most underwent revision via RYGB. Further inquiry is needed to tailor operative approaches and pre-operative optimization for revisional surgery patients.
Graphical abstract</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-023-10500-4</identifier><identifier>PMID: 37907658</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Bariatric Surgery - adverse effects ; Bariatric Surgery - methods ; Gastrectomy - adverse effects ; Gastrectomy - methods ; Gastric Bypass - methods ; Gastroenterology ; Gastroesophageal reflux ; Gastroesophageal Reflux - etiology ; Gastroesophageal Reflux - surgery ; Gastrointestinal surgery ; Gynecology ; Hepatology ; Humans ; Laparoscopy - methods ; Medicine ; Medicine & Public Health ; Obesity, Morbid - surgery ; Proctology ; Reoperation - adverse effects ; Retrospective Studies ; Surgery ; Surgical anastomosis ; Surgical outcomes ; Surgical techniques ; Treatment Outcome ; Weight Loss</subject><ispartof>Surgical endoscopy, 2024, Vol.38 (1), p.75-84</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-91bce7b0c52c8ebf0906ee50e0fc77d9fd750799853a9019440fbe55de6e37863</citedby><cites>FETCH-LOGICAL-c375t-91bce7b0c52c8ebf0906ee50e0fc77d9fd750799853a9019440fbe55de6e37863</cites><orcidid>0000-0002-2108-6566</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-023-10500-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-023-10500-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37907658$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>MacVicar, Sarah</creatorcontrib><creatorcontrib>Mocanu, Valentin</creatorcontrib><creatorcontrib>Jogiat, Uzair</creatorcontrib><creatorcontrib>Verhoeff, Kevin</creatorcontrib><creatorcontrib>Dang, Jerry</creatorcontrib><creatorcontrib>Birch, Daniel</creatorcontrib><creatorcontrib>Karmali, Shahzeer</creatorcontrib><creatorcontrib>Switzer, Noah</creatorcontrib><title>Revisional bariatric surgery for gastroesophageal reflux disease: characterizing patient and procedural factors and 30-day outcomes for a retrospective cohort of 4412 patients</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Introduction
Gastroesophageal reflux disease (GERD) is a well-established potential consequence of bariatric surgery and can require revisional surgery. Our understanding of the population requiring revision is limited. In this study, we aim to characterize patients requiring revisional surgery for GERD to understand their perioperative risks and identify strategies to improve their outcomes.
Methods
Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) registry, a retrospective cohort of patients who required revisional surgery for GERD in 2020 was identified. Multivariable logistic regression modelling was used to assess correlations between baseline characteristics and morbidity.
Results
4412 patients required revisional surgery for GERD, encompassing 24% of all conversion procedures. In most cases, patients underwent sleeve gastrectomy (SG) as their original surgery (
n
= 3535, 80.1%). The revisional surgery for most patients was a Roux-en-Y gastric bypass (RYGB) (
n
= 3722, 84.4%). Major complications occurred in 527 patients (11.9%) and 10 patients (0.23%) died within 30 days of revisional surgery. Major complications included anastomotic leak in 31 patients (0.70%) and gastrointestinal bleeding in 38 patients (0.86%). Multivariable analyses revealed that operative length, pre-operative antacid use, and RYGB were predictors of major complications.
Conclusion
GERD is the second most common indication for revisional surgery in patients who have undergone bariatric surgery. Patients who underwent SG as their initial procedure were the primary group who required revisional surgery for GERD; most underwent revision via RYGB. Further inquiry is needed to tailor operative approaches and pre-operative optimization for revisional surgery patients.
Graphical abstract</description><subject>Abdominal Surgery</subject><subject>Bariatric Surgery - adverse effects</subject><subject>Bariatric Surgery - methods</subject><subject>Gastrectomy - adverse effects</subject><subject>Gastrectomy - methods</subject><subject>Gastric Bypass - methods</subject><subject>Gastroenterology</subject><subject>Gastroesophageal reflux</subject><subject>Gastroesophageal Reflux - etiology</subject><subject>Gastroesophageal Reflux - surgery</subject><subject>Gastrointestinal surgery</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Laparoscopy - methods</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Obesity, Morbid - surgery</subject><subject>Proctology</subject><subject>Reoperation - adverse effects</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Surgical anastomosis</subject><subject>Surgical outcomes</subject><subject>Surgical techniques</subject><subject>Treatment Outcome</subject><subject>Weight Loss</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kc9u1DAQhy0EokvhBTggS1y4BMaOHcfcUMU_qRISgnPkOJNdV9k42E7V5aV4Raa7LUgcOFmyv_mNZz7Gngt4LQDMmwygGlWBrCsBGqBSD9hGqFpWUor2IduAraGSxqoz9iTnKyDeCv2YndXGgml0u2G_vuJ1yCHObuK9S8GVFDzPa9piOvAxJr51uaSIOS47t0XCEo7TesOHkNFlfMv9ziXnC6bwM8xbvrgScC7czQNfUvQ4rImqRkJiysdr-tXgDjyuxcc95mMbR7nUJy_oS7hG7uMupsLjyJUS8j41P2WPRjdlfHZ3nrPvH95_u_hUXX75-Pni3WXla6NLZUXv0fTgtfQt9iNYaBA1IIzemMGOg9FgrG117SwIqxSMPWo9YIO1aZv6nL065dIIP1bMpduH7HGa3IxxzZ1sWy1BgbWEvvwHvYprooUSZYUkVcrcUvJEeRoy0w67JYW9S4dOQHerszvp7Ehnd9TZKSp6cRe99nsc_pTc-yOgPgGZnmZy9rf3f2J_AzwQrgE</recordid><startdate>2024</startdate><enddate>2024</enddate><creator>MacVicar, Sarah</creator><creator>Mocanu, Valentin</creator><creator>Jogiat, Uzair</creator><creator>Verhoeff, Kevin</creator><creator>Dang, Jerry</creator><creator>Birch, Daniel</creator><creator>Karmali, Shahzeer</creator><creator>Switzer, Noah</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2108-6566</orcidid></search><sort><creationdate>2024</creationdate><title>Revisional bariatric surgery for gastroesophageal reflux disease: characterizing patient and procedural factors and 30-day outcomes for a retrospective cohort of 4412 patients</title><author>MacVicar, Sarah ; Mocanu, Valentin ; Jogiat, Uzair ; Verhoeff, Kevin ; Dang, Jerry ; Birch, Daniel ; Karmali, Shahzeer ; Switzer, Noah</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-91bce7b0c52c8ebf0906ee50e0fc77d9fd750799853a9019440fbe55de6e37863</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Abdominal Surgery</topic><topic>Bariatric Surgery - adverse effects</topic><topic>Bariatric Surgery - methods</topic><topic>Gastrectomy - adverse effects</topic><topic>Gastrectomy - methods</topic><topic>Gastric Bypass - methods</topic><topic>Gastroenterology</topic><topic>Gastroesophageal reflux</topic><topic>Gastroesophageal Reflux - etiology</topic><topic>Gastroesophageal Reflux - surgery</topic><topic>Gastrointestinal surgery</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Laparoscopy - methods</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Obesity, Morbid - surgery</topic><topic>Proctology</topic><topic>Reoperation - adverse effects</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Surgical anastomosis</topic><topic>Surgical outcomes</topic><topic>Surgical techniques</topic><topic>Treatment Outcome</topic><topic>Weight Loss</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>MacVicar, Sarah</creatorcontrib><creatorcontrib>Mocanu, Valentin</creatorcontrib><creatorcontrib>Jogiat, Uzair</creatorcontrib><creatorcontrib>Verhoeff, Kevin</creatorcontrib><creatorcontrib>Dang, Jerry</creatorcontrib><creatorcontrib>Birch, Daniel</creatorcontrib><creatorcontrib>Karmali, Shahzeer</creatorcontrib><creatorcontrib>Switzer, Noah</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>MacVicar, Sarah</au><au>Mocanu, Valentin</au><au>Jogiat, Uzair</au><au>Verhoeff, Kevin</au><au>Dang, Jerry</au><au>Birch, Daniel</au><au>Karmali, Shahzeer</au><au>Switzer, Noah</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Revisional bariatric surgery for gastroesophageal reflux disease: characterizing patient and procedural factors and 30-day outcomes for a retrospective cohort of 4412 patients</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2024</date><risdate>2024</risdate><volume>38</volume><issue>1</issue><spage>75</spage><epage>84</epage><pages>75-84</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Introduction
Gastroesophageal reflux disease (GERD) is a well-established potential consequence of bariatric surgery and can require revisional surgery. Our understanding of the population requiring revision is limited. In this study, we aim to characterize patients requiring revisional surgery for GERD to understand their perioperative risks and identify strategies to improve their outcomes.
Methods
Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) registry, a retrospective cohort of patients who required revisional surgery for GERD in 2020 was identified. Multivariable logistic regression modelling was used to assess correlations between baseline characteristics and morbidity.
Results
4412 patients required revisional surgery for GERD, encompassing 24% of all conversion procedures. In most cases, patients underwent sleeve gastrectomy (SG) as their original surgery (
n
= 3535, 80.1%). The revisional surgery for most patients was a Roux-en-Y gastric bypass (RYGB) (
n
= 3722, 84.4%). Major complications occurred in 527 patients (11.9%) and 10 patients (0.23%) died within 30 days of revisional surgery. Major complications included anastomotic leak in 31 patients (0.70%) and gastrointestinal bleeding in 38 patients (0.86%). Multivariable analyses revealed that operative length, pre-operative antacid use, and RYGB were predictors of major complications.
Conclusion
GERD is the second most common indication for revisional surgery in patients who have undergone bariatric surgery. Patients who underwent SG as their initial procedure were the primary group who required revisional surgery for GERD; most underwent revision via RYGB. Further inquiry is needed to tailor operative approaches and pre-operative optimization for revisional surgery patients.
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| subjects | Abdominal Surgery Bariatric Surgery - adverse effects Bariatric Surgery - methods Gastrectomy - adverse effects Gastrectomy - methods Gastric Bypass - methods Gastroenterology Gastroesophageal reflux Gastroesophageal Reflux - etiology Gastroesophageal Reflux - surgery Gastrointestinal surgery Gynecology Hepatology Humans Laparoscopy - methods Medicine Medicine & Public Health Obesity, Morbid - surgery Proctology Reoperation - adverse effects Retrospective Studies Surgery Surgical anastomosis Surgical outcomes Surgical techniques Treatment Outcome Weight Loss |
| title | Revisional bariatric surgery for gastroesophageal reflux disease: characterizing patient and procedural factors and 30-day outcomes for a retrospective cohort of 4412 patients |
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