Principals of Metabolic Revisional Surgery

We do not know how many patients have undergone revisionary bariatric and metabolic surgery worldwide. Each clinic has its own percentage of re-operations, and the range is said to be between 2% and 20%. Parallel to the development of new methods, we now are increasingly aware of a number of patients who want revisionary surgery due to low EWL after the primary operation. The establishment of a central data bank for all metabolic patients would help us to investigate the real incidence of re-operations. The development and improvement of diagnostic procedures and guidelines prior to revisionary surgery is still one of our main objectives. Bariatric re-operations are technically demanding. Primary bariatric operations are relatively safe; a meta-analysis reports mortality of 0.02–1% [1]. However, the re-operation rate has been as high as 56% in some series [2, 3]. In this chapter were present various options for revisionary surgery and point out factors that ought to be considered when choosing the right procedure.