Trends in bariatric surgery revisions: a 25-year single-institution experience.

Background: Revisional bariatric surgery (RBS) is now the third most performed metabolic and bariatric surgery (MBS) in the USA. This study aims to describe trends in MBS revisions at a single large academic institution over 25 years.

Methods: We identified patients who underwent an MBS revision between 2000 and 2024 at a single large quaternary referral center from a prospectively maintained database. We retrospectively reviewed the electronic medical records to collect pertinent data related to MBS history and conducted a descriptive review of the data to evaluate trends.

Results: A total of 667 patients underwent a first-time bariatric surgery revision; 364 (54.5%) performed surgically and 303 (45.5%) endoscopically. There was a noticeable trend toward endoscopic revisions indicated for weight-related indications, particularly over the past decade. For surgical revisions, Roux-en-Y gastric bypass (RYGB) was the most revised primary MBS operation overall, surpassed by sleeve gastrectomy (SG) in recent years. A greater diversity of indications was observed for surgical compared with endoscopic revisions. Additionally, 14.9% of patients required more than one bariatric revision procedure.

Conclusion: Bariatric surgery revisions are increasingly common, highlighting the chronicity of obesity and the need for long-term management. We identified general trends over time toward therapeutic interventions increasingly utilizing minimally invasive surgery and transoral endoscopic techniques. Transoral endoscopic revisions were primarily used for weight-related indications after RYGB, with many other indications managed exclusively through surgery.