Abstract
Background
Reoperations account for approximately 11% of annual metabolic and bariatric surgery cases in the United States. Indications vary and include weight-related and complication-related issues. The number of American Society for Metabolic and Bariatric Surgery (ASMBS)–endorsed procedures has grown in popularity since the original 2014 ASMBS publication on reoperative metabolic and bariatric surgery (rMBS).
Objectives
This paper was created as one of a 2-part update to the 2014 ASMBS publication on rMBS.
Setting
A literature review was conducted by the American Society of Metabolic and Bariatric Surgery’s Clinical Issues Committee. Available literature from 2014 to present was included.
Methods
A search was performed using Ovid MEDLINE and PubMed databases looking for studies related to surgical treatments for chronic complications after metabolic and bariatric surgery. Relevant studies were screened for inclusion by the authors.
Results
rMBS serves an important role in the care of chronic complications after all ASMBS-endorsed procedures. In many cases, data are limited in quality to retrospective case series. Prevention is essential to limiting chronic complications and their associated morbidity and mortality. Mesenteric defect closure in all anastomotic MBS procedures is of paramount importance. Once chronic complications occur, a step-wise multidisciplinary approach is recommended, beginning with medical therapy, followed by endoscopic interventions, and ultimately rMBS when indicated.
Conclusions
Surgeons should treat each patient presenting for rMBS on an individualized basis. Patient management should follow a structured escalation of care that prioritizes nonoperative treatments before progressing to rMBS.
Authors
- R. Wesley Vosburg, MD
- Jonathan Carter, MD
- Zhamak Khorgami, MD
- John Fam, MD
- Sofiane El Djouzi, MD
- Karen Diane Groller, PhD
- C. Joe Northup, MD
- Pavlos Papasavas, MD