Background

Evidence demonstrating the influence of revisional bariatric surgery on outcomes lacking. This study aims to examine the impact of revisional bariatric surgery on obesity-related metabolic outcomes.

Methods

Systemic review and meta-analysis. Searches of Medline, Embase, The Cochrane Library from 2007 – 2018 of studies conducted in English without restrictions to publication status. All study types reporting on metabolic outcomes after revisional bariatric surgery were considered. The literature search identified 35 relevant studies. These were categorized based on the predominant revision surgery examined in each study. Subgroup analysis examined outcomes of remission and improvement of diabetes, hypertension, hyperlipidemia and obstructive sleep apnea. Revision surgeries include sleeve gastrectomy (SG), roux-en-y gastric bypass (RYGB), pouch revision, duodenal switch and mini-gastric bypass.

Results

In 218 of 257 patients in 26 studies, revisional RYGB showed a non-significant improvement of diabetes with a RR 0.91 [0.87, 0.96]. Similarly, in 123 of 182 patients in 21 studies, revisional RYGB showed a significant remission of DM with RR 0.73 [0.65,0.80]. Only SG was found to have a significant improvement in hypertension with a RR 0.90 [0.77, 0.98]. Other revisional procedures did not induce any significant improvement in metabolic outcomes.

Conclusions

Revisional bariatric surgery in the form of RYGB continues to induce diabetes improvement and remission. The impact on metabolic outcomes for other revisional procedures however is not so clear and further longitudinal studies are required.