Revisional Bariatric Surgery for Malnutrition

Revisional surgery in patients who became malnourished following bariatric surgery for class I obesity is safe and effective, according to results of a study presented at the American Society for Metabolic and Bariatric Surgery’s 2022 annual meeting.

To better understand the impact of revisional bariatric surgery on nutrition status, researchers conducted a retrospective review. Patients who underwent revisional surgery for severe malnutrition between 2008 and 2020 were included. Data from 53 patients were analyzed.

Before revision, the anatomy was 8% restrictive and 93% bypass anatomy with a median of 2 (range 1-7) for bariatric operations and 3 (range 1-9) for abdominal operations.

Open approach was utilized in 70% (n=37) of operations. Laparoscopic operations were performed in 16 cases, of which 2 required conversion to open approach.

Preoperatively, 89% of patients required supplemental or total nutritional support, consisting of 47% on enteral feedings and 42% on TPN+-tube feedings. Following revision, this number decreased to 14%, with 8% on enteral feedings and 6% on TPN.

Researchers did not observe any associations between the discontinuation of supportive nutrition, Clavien-Dindo major complications, and any preoperative variables. Over the median 24-month follow-up period, 2 patents died within less than 1 year of their operation.

“Revisional surgery for severely malnourished bariatric surgery patients is effective in the discontinuation of supportive nutrition,” researchers concluded. “Postoperative complications are increased but not prohibitive.”

Researchers noted that many patients with BMIs below the standards of class I obesity (BMIs less than 35 kg/m2) may also benefit from bariatric surgeries. However, many health insurance companies still follow the National Institute of Health’s 1991 guidelines, which are said by many to be outdated.

—Leigh Precopio

Reference:

Sarr MG, Mundi MS, Dayyeh BA, et al. National trends in usage of bariatric surgery for class I obesity: an analysis of MBSAQIP. Poster presented at: American Society for Metabolic and Bariatric Surgery’s annual meeting; June 5-9, 2022; Dallas, TX. Accessed June 10, 2022. https://asmbsmeeting.com/abstract/national-trends-in-usage-of-bariatric-surgery-for-class-i-obesity-an-analysis-of-mbsaqip/