MSS861: COMPARATIVE ANALYSIS OF WEIGHT LOSS AND METABOLIC OUTCOMES FOLLOWING PRIMARY VERSUS REVISIONAL ROUX-EN-Y GASTRIC BYPASS IN A MILITARY TREATMENT FACILITY
Michael T Olson, MD; Yun Beom Lee, MD; Brian Layton, DO; Pamela Masella, DO; Department of Minimally Invasive and Bariatric Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
Objectives: Many patients with obesity require revisional bariatric surgery for weight recidivism or postsurgical complications. However, weight loss trajectories and changes in metabolic profiles are not well characterized following revisional bariatric surgery compared to the primary operation. We aimed to compare weight loss, metabolic improvements, and medication and therapy reductions between primary and revisional Roux-en-Y gastric bypass (RNYGB) from 12 to 24 months postoperatively.
Methods: We conducted a retrospective cohort study of consecutive patients undergoing laparoscopic RNYGB between 01/01/2023 and 01/01/2024 by two surgeons at a tertiary military treatment facility. Patients were categorized as primary versus revisional RNYGB. Weight loss outcomes were assessed using percent total weight loss (TWL%) at 6, 12, and 24 months. Metabolic outcomes included baseline and 12-month hemoglobin A1c (HbA1c) and lipid profiles, as well as de-escalation of antihypertensives, statins, and CPAP therapy for obstructive sleep apnea. Continuous variables were compared using t-tests or Wilcoxon tests; categorical variables were compared using Chi-square or Fisher’s exact tests.
Results: A total of 68 consecutive patients underwent laparoscopic RNYGB during the study period: 52 (76.4%) primary and 16 (23.5%) revisional. Thirteen (81.3%) patients underwent sleeve-to-RNYGB conversion; the remaining three patients underwent gastric band-to-RNYGB conversion. The most common indication for revisional surgery was combined weight recidivism and reflux (N=7), followed by reflux alone (N=6), and weight recidivism alone (N=3). Primary RNYGB patients had higher mean preoperative weight and BMI than revisional patients (113.0 vs 97.4 kg, 41.1 vs 37.5, p=0.076 and p=0.053, respectively). Primary and revisional RNYGB were similar in age (mean 46.0 vs 48.5 years, p=0.38), female sex (82.7% vs 87.5%, p=0.95), and frequencies of all preoperative comorbidities. Primary RNYGB achieved greater mean TWL% at 6 months, 12 months, and 24 months. Lipid profiles and glycemic control improved in both cohorts at 12 months, without significant difference between groups. Rates of de-escalation of antihypertensives, statins, and CPAP therapy were similar between groups. Weight loss trajectories and metabolic outcomes are summarized in Table 1.
Conclusions: Both primary and revisional RNYGB resulted in significant improvements in weight and metabolic outcomes in the short-term. Primary RNYGB achieved greater total weight loss, likely influenced by higher preoperative weight, whereas revisional procedures, often performed for reflux disease with or without weight recidivism, demonstrated comparable improvements in metabolic parameters and therapy de-escalation. These findings suggest that revisional RNYGB can achieve meaningful health benefits even when weight loss is less pronounced.
