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Background

Weight regain (WR) after bariatric surgery occurs in nearly 20% of patients. Revisional bariatric surgery (RBS) may benefit this population, however, it remains controversial among surgeons. The aim of this study was to explore surgeon perspectives and practices for patients with WR after bariatric surgery.

Methods

A 39-item survey was piloted and posted on Facebook forums utilized by bariatric surgeons. Survey items included demographic information, questions pertaining to the definition of failure and success after bariatric surgery, and clinical vignettes involving revisional practices.

Results

110 surgeons from 19 countries responded to the survey. Only two surgeons (2.4%) did not perform RBS citing insufficient experience and reduced effectiveness compared to non-operative treatments. Failure of bariatric surgery was defined as EWL<50% by 31.4%, as comorbidity recurrence by 17.4%, and as EWL<25% by 12.8%. Surgeon responses differed significantly by gender (p= 0.036, figure 1). 29.4% of respondents indicated that RBS is not successful in most WR patients, while 14.1% were undecided. 73% reported that they would be very likely to recommend RBS if sufficient evidence of benefit existed. Most frequently performed RBS procedures include conversion of sleeve gastrectomy to Roux-en-Y gastric bypass, adjustable gastric band to RYGB, and RYGB revision (21.9% vs 18.2% vs 15.3%, respectively).

Conclusions

This survey demonstrates significant variability in surgeon opinions regarding what constitutes failure after bariatric surgery and to whom they offer RBS. These findings may relate to limited available clinical evidence on best management options for this patient population. Clinical trials investigating comparative effectiveness of various treatment options are needed.