No guidelines are available to assist surgeons in determining whether reversal is appropriate for patients with problematic bariatric operations.
A retrospective review of 2573 primary and 252 revisional bariatric operations was performed to determine the indications for the reversal of problematic bariatric operations.
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.
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.