• Daniel Gero, Marie Vannijvel, Sietske Okkema, Ellen Deleus, Aaron Lloyd, Emanuele Lo Menzo, George Tadros, Ivana Raguz, San MartinAndresABariatric and Metabolic Center, Department of Surgery, Clinica Las Condes, Las Condes, Santiago, Chile., Marko Kraljević, Styliani Mantziari, Sebastien Frey, Lisa Gensthaler, Henna Sammalkorpi, José Luis Garcia-Galocha, Amalia Zapata, Talar Tatarian, Tom Wiggins, Ekhlas Bardisi, Jean-Philippe Goreux, Yosuke Seki, René Vonlanthen, Jeannette Widmer, Andreas Thalheimer, Kazunori Kasama, Jacques Himpens, Marianne Hollyman, Richard Welbourn, Rajesh Aggarwal, Alec Beekley, Matias Sepulveda, Antonio Torres, Anne Juuti, Paulina Salminen, Gerhard Prager, Antonio Iannelli, Michel Suter, Ralph Peterli, Camilo Boza, Raul Rosenthal, Kelvin Higa, Matthias Lannoo, Eric J Hazebroek, Bruno Dillemans, Pierre-Alain Clavien, Milo Puhan, Dimitri A Raptis, and Marco Bueter.
• Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
• Ann. Surg. 2021 Nov 1; 274 (5): 821828821-828.

ObjectiveTo define "best possible" outcomes for secondary bariatric surgery (BS).BackgroundManagement of poor response and of long-term complications after BS is complex and under-investigated. Indications and types of reoperations vary widely and postoperative complication rates are higher compared to primary BS.MethodsOut of 44,884 BS performed in 18 high-volume centers from 4 continents between 06/2013-05/2019, 5,349 (12%) secondary BS cases were identified. Twenty-one outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of centers. Benchmark cases had no previous laparotomy, diabetes, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, thromboembolic events, BMI> 50 kg/m2 or age> 65 years.ResultsThe benchmark cohort included 3143 cases, mainly females (85%), aged 43.8 ± 10 years, 8.4 ± 5.3 years after primary BS, with a BMI 35.2 ± 7 kg/m2. Main indications were insufficient weight loss (43%) and gastro-esophageal reflux disease/dysphagia (25%). 90-days postoperatively, 14.6% of benchmark patients presented ≥1 complication, mortality was 0.06% (n = 2). Significantly higher morbidity was observed in non-benchmark cases (OR 1.37) and after conversional/reversal or revisional procedures with gastrointestinal suture/stapling (OR 1.84). Benchmark cutoffs for conversional BS were ≤4.5% re-intervention, ≤8.3% re-operation 90-days postoperatively. At 2-years (IQR 1-3) 15.6% of benchmark patients required a reoperation.ConclusionSecondary BS is safe, although postoperative morbidity exceeds the established benchmarks for primary BS. The excess morbidity is due to an increased risk of gastrointestinal leakage and higher need for intensive care. The considerable rate of tertiary BS warrants expertise and future research to optimize the management of non-success after BS.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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