NON-RESPONSE AFTER GASTRIC BYPASS AND SLEEVE GASTRECTOMY - THE THEORETICAL NEED FOR REVISIONAL BARIATRIC SURGERY RESULTS FROM THE SCANDINAVIAN OBESITY SURGERY REGISTRY : Revisional surgery

• Background: Revisional surgery is a second-line treatment option after sleeve gastrectomy (SG) and gastric bypass (GBP) in patients with primary or secondary non-response. This study is an analysis of the theoretical need for revisional surgery when applying four indication benchmarks.Objective: The aim was to analyze the risk for primary and secondary non-response after SG and GBP.Setting: 44 hospitals in Sweden.Methods: Based on data from the Scandinavian Obesity Surgery Registry, SG and GBP were compared regarding four endpoints: 1. Excess Weight Loss (%EWL) < 50%; 2. weight regain of more than 10 kg after nadir; 3. fulfillment of IFSO-guidelines; or 4. ADA-criteria for bariatric surgery two years after primary surgery.Results: 60 426 individuals were included in the study (SG: n=7856 and GBP: n=52 570). Compared to patients in the GBP-group, more SG patients failed to achieved a %EWL > 50% (23.0% versus 8.5%, p < .001), regained more than 10 kg after nadir (4.3% versus 2.5%, p < .001), more often fulfilled the IFSO-criteria (8.0% vs. 4.5%, p < .001) or the ADA criteria (3.3% vs. 1.8%, p < 001) for bariatric/metabolic surgery at the 2-year follow-up.Conclusions: SG is associated with a higher risk for primary and secondary non-response compared to gastric bypass. To offer revisional bariatric surgery to all non-responders exceeds the bounds of feasibility and operability. Hence, individual prioritization and intensified evaluation of alternative second-line treatments is necessary.

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MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

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