Revisional Bariatric Surgery Carries Significantly Higher Complication Risk, New Study Finds
France: Revisional bariatric surgery accounts for a growing share of obesity-related operations in France and carries a substantially higher risk of serious postoperative complications compared with primary procedures, a new study published in the International Journal of Obesity has shown.
The research was led by A. Lazzati from the Department of Digestive, Bariatric and Endocrine Surgery at Avicenne Hospital, Sorbonne Paris Nord University, Paris, France, and colleagues.
Metabolic and bariatric surgery is widely recognized as an effective intervention for severe obesity, and its use has expanded steadily in France. However, a subset of patients requires revisional metabolic and bariatric surgery (RMBS) because of insufficient weight loss, weight regain, or complications related to the initial operation. To better understand national trends and associated risks, investigators conducted a large observational analysis using French national hospital discharge data from 2016 to 2022.
The study included 284,271 bariatric procedures performed in 279,285 adults. Primary surgeries served as the reference group, while revisional procedures were categorized based on the original operation: revision after adjustable gastric banding, after sleeve gastrectomy, or after gastric bypass. The primary endpoint was the occurrence of severe complications—defined as Clavien-Dindo grade 3 or higher—within 90 days of surgery. Additional outcomes included abdominal sepsis, such as gastric leaks or peritonitis, and significant bleeding events.
The following were the key findings of the study:
- Revisional procedures accounted for 12.8% of all bariatric surgeries.
- Patients undergoing revisional surgery were older, predominantly women, and had more comorbidities than those undergoing primary surgery.
- Severe complications occurred in 2.5% of primary procedures.
- Severe complication rates were higher in revisional surgeries: 3.4% after adjustable gastric banding, 6.9% after sleeve gastrectomy, and 9.0% after gastric bypass.
- Revisional surgery was associated with a 58% higher risk of severe complications compared with primary surgery.
- The highest risk was seen in revisions after gastric bypass, with nearly threefold increased odds of severe complications.
- Revisional sleeve gastrectomy had significantly higher morbidity than primary sleeve gastrectomy.
- Elevated complication risks were also observed when gastric bypass was performed as a secondary procedure after earlier restrictive surgeries.
The findings indicate a shift toward more technically complex revisional procedures, particularly gastric bypass, which was frequently selected as the revision strategy. The authors emphasize that these higher complication rates underscore the need for thorough preoperative evaluation, careful patient selection, and individualized postoperative care plans.
As bariatric surgery volumes continue to rise, understanding the risks associated with secondary procedures is essential. The investigators call for further research exploring surgical techniques, long-term medical therapies, and the role of surgeon experience in improving outcomes. Strengthening perioperative strategies may help mitigate complications and enhance safety for patients requiring revisional bariatric surgery.
Reference:
Lazzati, A., Tresallet, C., Guian, G., & Blanchard, C. (2026). Investigating the trend of revisional bariatric surgery, the complications, and associated risk factors in France. International Journal of Obesity, 1-7. https://doi.org/10.1038/s41366-025-01990-4
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