Revisional bariatric surgery can improve refractory metabolic disease

Background: It remains unclear if patients undergoing revisional surgery for inadequate weight loss/recidivism can achieve improvement of refractory metabolic syndrome (MetS). Objective: We aimed to evaluate metabolic outcomes after reoperative bariatric surgery for unsatisfactory weight loss in patients with refractory MetS. Setting: Academic Hospital. Methods: We retrospectively reviewed all revisional bariatric surgery cases performed for inadequate weight loss/recidivism at our center and analyzed all cases in which the patient had ongoing uncontrolled diabetes or MetS. Results: In total, 121 reoperative bariatric cases for inadequate weight loss/recidivism were identified. Of those, 31.4% (N = 38) had MetS and 33.9% (N = 41) were diabetic at the time of primary bariatric surgery. At revisional surgery, 15 (39.5%) patients still met criteria for MetS and 7 (17.1%) had hemoglobin A(1c) (HbA(1c)) >= 6.0%. Of those with refractory MetS (N = 15) at revisional surgery, a mean percent excess weight loss (%EWL) of 59.4 +/- 21.2% at mean 40.1 +/- 29.9 months follow-up corresponded to a mean decrease in triglyceride of 65.2 mg/dL, mean increase in high density lipoprotein cholesterol (HDL) of 12.1 mg/dL, and mean decrease in plasma glucose of 58.8 mg/dL. Mean percent total weight loss was 27.3%. One patient still met criteria for MetS. Of those with HbA(1c) >= 6.0% at reoperative surgery (N = 7), a mean %EWL of 63.0 +/- 22.9% at mean 51.6 +/- 36.6 months follow-up corresponded to a mean decrease in HbA(1c) of 1.6%. Three patients still had HbA(1c) >= 6.0%, but only 1 had HbA(1c) >= 6.5%. Conclusion: Although further research is needed, this report suggests that revisional bariatric surgery is capable of treating both inadequate weight loss and refractory metabolic disease. (C) 2016 American Society for Metabolic and Bariatric Surgery. All rights reserved.