Rationale for reversal of failed bariatric operations

Background: No guidelines are available to assist surgeons in determining whether reversal is appropriate for patients with problematic bariatric operations. Methods: A retrospective review of 2573 primary and 252 revisional bariatric operations was performed to determine the indications for the reversal of problematic bariatric operations. Results: Of the 82 patients who had undergone reoperation for complications of the primary operation, 13 had undergone reversal rather than revision. Reversal was performed at the patient's request for 5 patients with intractable vomiting after banded restrictive operations and 2 patients with intractable diarrhea after jejunoileal bypass. The surgeon recommended reversal for the remaining 6 patients, including 3 with active substance abuse and 3 with severe metabolic complications. One postoperative complication (wound infection) occurred, with no deaths. Conclusion: The decision to reverse, rather than revise, a problematic bariatric operation is motivated by the perspective that the outcome of revision would also be problematic. Improved patient education and follow-up by the primary surgeon might have obviated the need for reversal in about one half of the patients in the present series. (Surg Obes Relat Dis 2009;5:673-677.) (C) 2009 American Society for Metabolic and Bariatric Surgery. All rights reserved.