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Page 2 of 8 Spurzem et al. Mini-invasive Surg. 2025;9:10 https://dx.doi.org/10.20517/2574-1225.2024.96

readmission rate was 5.7% (N = 4) and there were no 30-day mortalities.

Conclusion: Revisional bariatric surgery is an effective tool for addressing weight regain and achieving sustained
weight loss. Among the revisional options, converting SG to OAGB was most effective at promoting significant
weight loss at 12 months. These findings highlight the important role of tailored revisional procedures in the
broader context of bariatric care.

Keywords: Revisional bariatric surgery, weight regain, gastric bypass, sleeve gastrectomy

INTRODUCTION
Weight recidivism following bariatric surgery is a significant clinical challenge with both physical and
psychological consequences. Although metabolic and bariatric surgery (MBS) is the most effective evidence-
based therapy for obesity, up to 30% of patients experience significant weight regain within five years
[1,2]
postoperatively . Weight regain can compromise a patient’s quality of life and lead to the recurrence of
several obesity-related comorbidities, such as type 2 diabetes, cardiovascular disease, and sleep apnea .
[3,4]
Additionally, the psychological toll of weight regain is an important consideration, as many patients
experience feelings of failure, frustration, and lowered self-esteem, which can exacerbate underlying
depression and anxiety .
[5]
Revisional bariatric surgery is a common therapeutic option used to address weight regain. There are also
several emerging medical weight loss therapies, such as glucagon-like peptide 1 (GLP-1) receptor agonists,
that have demonstrated efficacy in treating weight regain . However, revisional bariatric procedures are
[6]
often more technically challenging than primary surgery due to the presence of altered anatomy in
reoperative surgical fields. Revisional procedures are generally associated with higher postoperative
morbidity compared to primary bariatric surgery due to these factors . Despite these risks, revisional
[7]
surgery can provide meaningful weight loss and improvements in obesity-related comorbidities for patients
[8,9]
who experience unsatisfactory weight loss or significant weight gain after their initial procedure .

The purpose of this investigation was to evaluate the efficacy and safety of revisional bariatric surgery for
weight regain at our institution. We assess the perioperative and weight loss outcomes for several revisional
bariatric procedures to better characterize the risk-benefit profile of revisional surgery and to inform patient
decision making.

METHODS
Patient selection and demographics
A retrospective database review identified patients who underwent revisional bariatric surgery for weight
regain at our academic center from 2014 to 2023. Emergent operations were excluded. Patient
characteristics included age, sex, body mass index (BMI) at the time of revisional surgery, Charlson
Comorbidity Index (CCI), surgical approach, operative time, hospital length of stay (LOS), and follow-up
time. The type of initial and revisional bariatric procedure that each patient underwent was also tabulated.

Weight loss and perioperative outcomes
The primary outcomes were percentage total (%TWL) and excess weight loss (%EWL) using weight at the
time of revisional surgery as the baseline. Weight loss was calculated at 3, 6, 9, and 12 months
postoperatively. Weight loss outcomes were compared between each type of revisional procedure at 12
months to determine the procedure that was most effective at treating weight regain. Secondary outcomes
were 30-day morbidity, mortality, readmission, and reoperation rates.