Impact of previous abdominal surgeries on metabolic and bariatric surgery outcomes.

Abstract

Metabolic and bariatric surgery yields substantial weight loss while maintaining a favorable safety profile. The effects of previous abdominal surgery on metabolic and bariatric surgery outcomes remain underexplored. This single-center retrospective cohort study examined patients who underwent metabolic and bariatric surgery between January 2008 and December 2023 at a specialized tertiary center. Patients were stratified into 3 groups: (1) no previous abdominal surgery, (2) major previous abdominal surgery, or (3) minor previous abdominal surgery. Specific surgical variables including number and location of previous abdominal surgery were examined on subgroup analysis. Data collected over 5 years included baseline and intraoperative characteristics and postoperative outcomes. Statistical tests included χ², Kruskal-Wallis, analysis of variance, post hoc analyses, and multivariate regression. Of 3,202 patients, 1,141 (35.6%) had no previous abdominal surgery, 1,629 (50.9%) had minor surgery, and 432 (13.5%) had major surgery. Patients with major previous abdominal surgeries had a higher rate of lysis of adhesions (P < .001) and conversion to open (P = .04). Sleeve gastrectomy was also significantly prolonged in patients with major previous abdominal surgeries (P < .001). Postoperatively, patients with previous abdominal surgeries had higher rates of early strictures (P = .04), urinary complications (P = .002), small-bowel obstructions (P < .001), and marginal ulcers (P = .01). Patients with previous abdominal surgeries also underwent more reoperations (P < .001), most commonly for small-bowel obstructions. Anastomotic metabolic and bariatric surgery and number of previous abdominal surgeries were independent predictors of multiple outcomes. Weight loss outcomes were comparable across the cohort. A detailed surgical history is essential in candidates for metabolic and bariatric surgery. Recognizing intraoperative complexity and anticipating complications can guide tailored approaches to improve outcomes in patients with previous abdominal surgeries, through informing procedure selection and guiding preoperative patient counseling regarding expected postoperative outcomes and the intraoperative potential for conversion to open, if significant intraoperative difficulty is encountered.