Revisional Surgery After Restrictive Procedures for Morbid Obesity

Bariatric surgery has become more common due to the worldwide obesity epidemic. A shift from open to laparoscopic surgery has occurred in the last 2 decades, because of its advantages. Revisional surgery after bariatric procedures is becoming an important issue, and restrictive procedures account for a large proportion of these interventions. Three restrictive procedures are currently in use: laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy and vertical banded gastroplasty. The first two procedures are more commonly used, and the third is losing favor with surgeons. All three have proven effective, but less than malabsortive or combined procedures. The reasons to reoperate upon a patient and convert a previous bariatric procedure to a different one are failure of the operation, due to insufficient weight loss, or weight regain (secondary obesity); or complications like penetration, infection, bleeding, obstruction, dysphagia, and gastroesophageal reflux, among others. This review will describe the complications or failures leading to the a second operation; the conditions present after the first procedure and the presence of failure or complications; the technical steps required to be taken; and the outcomes and what can be expected afterwards.