LAUSR

BACKGROUND Malnutrition after bariatric surgery is a rare yet potentially life-threatening complication. The safety and efficacy of revisional bariatric surgery in malnourished patients are not well elucidated. METHODS We performed a retrospective chart review of patients who underwent revisional bariatric surgery for severe malnutrition at our institution between 2008 and 2020. Associations of demographic and clinical characteristics with dichotomous outcomes of interest were examined using Fisher exact tests, Cochran-Armitage tests for trend, and two-sample t-tests when appropriate. RESULTS Fifty-three patients underwent revisional bariatric surgery for malnutrition from 2008 and 2020. The median follow-up was 24 months. The anatomy before revision was Roux-en-Y gastric bypass (RYGB) (n=40, 75%), biliopancreatic diversion with duodenal switch (DS) (n=6, 11%), sleeve gastrectomy (SG) (n=4, 8%), and mini-gastric bypass (n=3, 6%). The percentage of patients requiring supplemental or total nutritional support decreased from 89% preoperatively (47% on enteral feedings and 42% on TPN±tube feedings) to 13.2% at the last encounter after revision (7.5% still requiring enteral feedings and 5.7% on TPN). There was an association between the number of prior abdominal operations and postoperative pneumonia (p 0.03), and need for blood transfusion (p 0.01). There were no associations between major complications or last encounter nutrition and any preoperative variables other than age at the time of surgery. There were 2 mortalities during a median follow-up of 24 months and both occurred >1 year postoperatively. CONCLUSION Revisional surgery for severely malnourished bariatric surgery patients is effective in the discontinuation of supportive nutrition. Postoperative complications are increased but not prohibitive.