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Revisional surgery

Uniform definition of failure in revisional surgery required

There are no agreed definitions as to what constitutes a ‘failure’ of the primary bariatric procedure

Although bariatric surgery is effective in achieving weight loss and remission of type 2 diabetes, some 7-8% of patients undergo repeat procedures. Despite this, there are no agreed definitions as to what constitutes a ‘failure’ of the primary bariatric procedure, said presenter Jake Mann University of Cambridge, Cambridge, UK, speaking at the 6th Annual Meeting of the British Obesity and Metabolic Surgical Society 21-23 January, in Newcastle, UK.

As a result, the researchers wanted to ascertain how failure is defined in published studies of bariatric surgery and carried out a literature review. Data extracted included: patient demographics, primary and revisional bariatric procedures performed, indications for revision, and definitions used for each indication.

Jake Mann

In total, 174 studies were retrieved and after duplicates and exclusions were removed 60 articles underwent analysis, which included 4,148 revisional bariatric procedures; average age 44 years, 82% female (4/52 studies listed no demographics). Some 2,741 indications were listed: 1,614 (59%) for inadequate weight loss or weight regain, 832 (30%) for mechanical complications, 211 (8%) for intolerance or other patient factors, and 84 (3%) for nutritional deficiencies.

Fifty-one studies included inadequate weight loss or weight regain as a indication for revision; 31/51 (61%) gave no definition for failure. 20/51 studies offered a definition, including 11 different measures of weight loss or gain. Seven of 20 studies quoted the 1991 NIH criterion (<50% of excess weight loss at 18 months) and 6/20 used the Reinhold criterion (<25% excess weight loss). The remaining seven used a wide variety of absolute values and units.

 “The majority of published studies do not describe how patients were deemed to have failed their primary bariatric procedure, and in those that do these is great variation,” he concluded. “There is a need for increased reporting of patient selection and a uniform definition of failure in revisional bariatric surgery.”

Co-authors for the paper were Adam Jakes, Jeremy Hayden and Julian Barth Obesity Clinic, Leeds Teaching Hospitals NHS Trust, Leeds, UK)

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