Outcomes and Management of Re-establishing Bariatric Patients' Care
Pourya Medhati*, Eric Sheu, Ali Tavakkoli
Surgery, Brigham and Women's Hospital, Boston, MA
Objective. Bariatric surgical patients are advised to have regular and lifelong follow up to monitor their outcomes and nutritional status. However, many patients do not routinely follow up with their surgical team. We studied a cohort of post-bariatric surgery patients who had been lost to follow-up but presented to re-establish bariatric care (RBC), to understand symptoms, and recommend a management strategy for this group of patients.
Design. Retrospective cohort study.
Setting. Single academic medical center.
Patients. Post-primary bariatric surgery patients who had discontinued regular bariatric surgical follow-up but were represented to the clinic between February 2019 and December 2022 to re-establish care. Patients with a history of a primary Sleeve Gastrectomy (SG), Roux-En-Y Gastric Bypass (RYGB), and Laparoscopic Banding (LB) were included.
Main Outcome Measures. Presenting symptoms, weight changes after surgery, and interventions employed for symptoms and weight management.
Results. We identified 300 patients (84% female, mean age 50.5"±12.6 years), of whom 139 (46.3%) had RYGB, 114 (38%) had SG, and 47 (15.7%) had LB. The average time from the original surgery to clinic presentation was 6.4"±2.4 years, 12.59"±5.9 years, and 12.1"±2.6 years, for SG, RYGB, and LB, respectively (p<0.001). The average follow-up length after clinic visit was 15.2"±12.7 months. Weight regain was the most common reason for presentation (80% SG, 61% for RYGB, and 64% LB; p=.008), followed by reflux (47% SG, 25% for RYGB, and 36% LB; p=.001). As demonstrated in Figure 1, RYGB had regained 49% of their maximum weight loss, which was significantly lower than SG (61.6%) and LB (68.7%) (p=0.003). Most patients were referred to a medical weight management group (86% SG, 65% for RYGB, and 60% LB; p<.001). Additionally, SG patients were more likely to undergo surgical intervention than RYGB patients (24.6% vs. 14.4%, p<.001), but RYGB patients had more endoscopic interventions than SG patients (15.8% vs. 3.5%, p<.001).
Conclusion. Our study highlights weight regain and reflux as the most common reasons for post-bariatric surgery patients seeking to re-establish care with the surgical team. SG patients were more likely to have regained more weight, have more reflux symptoms, and require more revisional surgery to manage their symptoms. SG is the most commonly performed bariatric operation, but these long-term risks need to be carefully considered when choosing between various bariatric operations.
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