BACKGROUND: Obesity is linked to increased risk of cardiovascular disease, type 2 diabetes, and overall mortality. Bariatric surgery effectively achieves long-term weight loss, especially in clinically severe obesity. Po...BACKGROUND: Obesity is linked to increased risk of cardiovascular disease, type 2 diabetes, and overall mortality. Bariatric surgery effectively achieves long-term weight loss, especially in clinically severe obesity. Postoperative weight loss is associated with increased N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, without signs of cardiac dysfunction. OBJECTIVES: We investigated longitudinal changes in NT-proBNP levels following different bariatric procedures and examined their associations with metabolic alterations. SETTING: This retrospective study was conducted in a large university hospital in central Europe using data from 2005 to 2016. METHODS: We analyzed preoperative and postoperative laboratory results from 508 patients undergoing three different bariatric procedures. Follow-up records were available for 347 (68.3%) patients at month 3, 260 (51.2%) at month 6, 152 (29.9%) at month 9, 183 (36.0%) at month 12, 166 (32.7%) at month 18, and 127 (25.0%) at month 24 postsurgery. RESULTS: NT-proBNP levels rose shortly after bariatric surgery and remained elevated, with no significant differences between surgical types. Women exhibited significantly higher postoperative NT-proBNP concentrations than men. The increase in NT-proBNP correlated with improved insulin resistance but not with other metabolic parameters. We found no evidence supporting reduced renal clearance as a cause for elevated natriuretic peptides. CONCLUSIONS: Our data suggest a link between the NT-proBNP increase and reduced hyperinsulinemia following bariatric surgery, offering new insights into mechanisms underlying this frequent postoperative finding.
BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly prevalent medications used to treat patients with obesity. While bariatric surgery remains the most successful single intervention, many s...BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly prevalent medications used to treat patients with obesity. While bariatric surgery remains the most successful single intervention, many surgical patients have been on a GLP-1RA. OBJECTIVES: This study aims to determine if the neoadjuvant use of GLP-1RA affects surgical weight loss. SETTING: University Hospital, United States. METHODS: This retrospective cohort study compared outcomes of patients undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) who were treated preoperatively with and without GLP-1RAs from July 2022 to June 2023. T-tests and multivariable analyses were utilized to determine significant differences in weight loss. RESULTS: Of 422 patients, 36 (8.5%) received neoadjuvant GLP-1RAs and 386 (91.5%) did not. Mean preoperative body mass index (BMI) was 47 for both groups. Median time for GLP1-RAs was 12 months prior to bariatric surgery but not resumed after. There was a significant difference between patients who received neoadjuvant GLP1-RAs versus those who did not at 2 weeks (mean change in BMI of -4.9 vs -3.8, P = .006), but not at 3- (-9 vs -8.4, P = .25), 6- (-12.4 vs -11.2, P = .13), or 12 months (-14.2 [n = 21] vs -12.9 [n = 249], P = .25) postoperatively. Multivariable analysis showed no difference in weight loss at any time point when adjusting for operation type. CONCLUSIONS: Although neoadjuvant GLP-1RAs did not significantly impact weight loss after bariatric surgery, there was an additive weight loss effect.
BACKGROUND: Eating disorders are routinely assessed for in persons seeking metabolic and bariatric surgery (MBS). One construct in particular, loss-of-control over eating, appears to be important to understanding clinica...BACKGROUND: Eating disorders are routinely assessed for in persons seeking metabolic and bariatric surgery (MBS). One construct in particular, loss-of-control over eating, appears to be important to understanding clinical needs and outcomes in MBS. The Eating Loss of Control Scale (ELOCS) has received some initial validation for use in MBS settings, but its factor structure remains uncertain and its performance about diverse groups is unknown. OBJECTIVES: The purpose of this study is to explore further the psychometric properties and factor structure of ELOCS in Hispanic persons seeking MBS and to establish measurement invariance between the English- and Spanish-language version. SETTING: Academic Medical Center METHODS: Participants (n = 618) undergoing evaluations prior to bariatric surgery who identified as Hispanic and consented to participate in this research study completed self-report measures of eating disorders and loss of control over eating. Of the 618 participants, a total of 318 persons preferred English and were administered English versions of the measures and 300 persons preferred Spanish and were administered Spanish versions of the measures. RESULTS: Factor analyses supported a one-factor, 18-item ELOCS (after removal of 2 original items 6 and 20), though Comparative Fit Index (CFI) was slightly below conventional cut-offs and RMESA were mediocre. The measure was also invariant across language translations. The 18-item ELOCS had good internal consistency (α = .97), though the internal consistency suggests that there is still considerable redundancy on the measure. The ELOCS-18 also demonstrated good convergent and discriminant validity with an established eating disorder measure. CONCLUSIONS: The 18-item ELOCS is a reliable and valid measure to use in MBS settings, though factor analyses suggest further psychometric work is warranted. A Spanish-translated version assesses the construct of LOC similarly to its English counterpart. Due to some below threshold indices, the ELOCS factor structure should be further studied.
BACKGROUND: The management of individuals receiving chronic anticoagulation (CAC) who are undergoing bariatric surgery presents a complex challenge, because there is a delicate balance between risks of perioperative blee...BACKGROUND: The management of individuals receiving chronic anticoagulation (CAC) who are undergoing bariatric surgery presents a complex challenge, because there is a delicate balance between risks of perioperative bleeding and thromboembolic events. OBJECTIVES: To evaluate and compare rates of bleeding, thrombotic events, and overall outcomes of patients on CAC undergoing bariatric surgery. SETTING: United States. METHODS: Data spanning 2020 to 2021 were extracted from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, with a focus on patients who underwent primary minimally invasive bariatric surgery. A multivariable regression analysis examined 30-day outcomes for patients anticoagulated preoperatively. In addition, a propensity-matched analysis was performed comparing outcomes among patients on CAC and those without. RESULTS: In total 331,201 patients were analyzed, with 8428 (2.5%) receiving CAC. Propensity score matching revealed that patients on CAC exhibited greater rates of reoperations within 30 days (1.9% versus 1.3%, P < .001), overall readmissions after 30 days (7.2% versus 3.3% respectively, P < .0001), and reinterventions within 30 days (1.6% versus .9%, P < .0001) compared with patients not on preoperative CAC. Transfusion intra/postoperative and postoperative gastrointestinal tract bleeding events were elevated in the preoperative therapeutic anticoagulant group (2.2% versus .8%, P < .0001 and 1.4% versus .3%, P < .0001, respectively) compared with no preoperative CAC group. CONCLUSIONS: Patients undergoing bariatric surgery while on preoperative CAC face significantly increased risks of adverse postoperative outcomes. Individuals requiring long-term anticoagulation should undergo careful consideration before proceeding with bariatric surgery.
Long-term outcomes of Roux-en-Y gastric bypass (RYGB) in adolescents are limited. This systematic review and meta-analysis evaluates the safety and efficacy of RYGB in adolescents with obesity. A comprehensive literature...Long-term outcomes of Roux-en-Y gastric bypass (RYGB) in adolescents are limited. This systematic review and meta-analysis evaluates the safety and efficacy of RYGB in adolescents with obesity. A comprehensive literature search was conducted across databases, including MEDLINE, EMBASE, Cochrane, and SCOPUS up to July 2023. Included studies reported outcomes for participants younger than 21 years of age undergoing RYGB, with a minimum follow-up of 2 years. A random-effects model was used for pooled analysis. Twelve studies were included involving 522 adolescents. The mean age was 17.5 years (13-21 years), 73.6% of patients were female, and the mean follow-up was 48.4 months. Baseline body mass index (BMI) was 50.1 kg/m. BMI reduction peaked at 1 year with an absolute reduction of 19.1 kg/m, 36.6% total loss, and 67.7% excess BMI loss. At 5 years, absolute reduction of BMI was 19.1 kg/m, percentage loss was 31.5%, and excess BMI loss was 70.5%. Comorbidity remission rates were 85% for dyslipidemia, 73% for hypertension, 85% for type 2 diabetes, and 68% for obstructive sleep apnea. Iron and vitamin B12 deficiency rates were greater postoperatively. The complication rate was 29.1%. RYGB in adolescents leads to significant weight loss and comorbidity resolution but carries risk of complications and requires monitoring for nutritional deficiencies. Further long-term studies are essential.
BACKGROUND: Adjustable gastric banding (AGB) was a widely performed bariatric surgery, but over time, sleeve gastrectomy (SG) became the most commonly performed procedure. Both AGB and SG carry the risk of weight regain,...BACKGROUND: Adjustable gastric banding (AGB) was a widely performed bariatric surgery, but over time, sleeve gastrectomy (SG) became the most commonly performed procedure. Both AGB and SG carry the risk of weight regain, which may require conversion to Roux-en-Y gastric bypass (RYGB). However, the impact of AGB prior to SG on postoperative outcomes after conversion to RYGB remains unclear. OBJECTIVES: The aim of this study is to compare the postoperative outcomes, including weight loss, between patients who underwent 3 bariatric procedures, including AGB, SG and finally conversion to RYGB and those who only underwent SG and conversion to RYGB. SETTING: University Hospital. METHODS: A retrospective analysis of patients who underwent SG conversion to RYGB between 2016 and 2024 was conducted. Demographics, perioperative outcomes, and weight loss were compared between patients with prior history of AGB and those without. RESULTS: A total of 122 patients were included, of whom 25 had AGB prior to SG conversion to RYGB. The body mass index (BMI) prior to the revision was 36.6 and 35.8kg/m, respectively. At the 2-year follow-up, data were available for 72.2% of the total cohort. There was no significant difference in operative times (P = .77) and early and late postoperative complications (P > .05). However, patients without a history of AGB demonstrated significantly greater weight loss at 6, 12, and 24 months postoperatively. Their percentage of total weight loss (%TWL) was 15.4%, 17.9%, and 19.1%, respectively, compared to 11.7%, 12.5%, and 13.3% in patients who had undergone AGB prior to SG conversion to RYGB (P = .012). CONCLUSIONS: Patients who underwent AGB prior to other bariatric procedures tend to experience poorer weight loss compared to those who did not have prior band.
BACKGROUND: The clinical impact of metabolic and bariatric surgery (MBS) before kidney transplantation (KTx) is evolving. METHODS: This was a single-center retrospective study of all adult patients between January 1, 199...BACKGROUND: The clinical impact of metabolic and bariatric surgery (MBS) before kidney transplantation (KTx) is evolving. METHODS: This was a single-center retrospective study of all adult patients between January 1, 1994, and December 31, 2024, undergoing KTx with a history of antecedent MBS. Primary outcomes included death-censored graft survival and overall patient survival. RESULTS: Among 4538 KTx recipients, 116 (2.6%) had a history of previous MBS. Median time (interquartile range, range) between BS and KTx was 6.8 years (10.9, .3-45.5). Of these, patients underwent Roux-en-Y gastric bypass (RYGB, n = 77, 66.4%), vertical sleeve gastrectomy (VSG, n = 23, 19.8%), gastric banding (n = 6, 5.2%), vertical banded gastroplasty (n = 5, 4.3%), jejunoileal bypass (n = 3, 2.6%), and duodenal switch (n = 2, 1.7%). The type of MBS (VSG versus RYGB) did not impact long-term outcomes. In total, 28 (24.1%) patients underwent planned BS with the specific intention of reaching an acceptable body mass index (BMI) threshold for KTx. Median time between BS and KTx for these patients was 1.1 years (1.3, .3-4.7). Nine patients underwent RYGB, and 19 underwent VSG. Median BMI (IQR) was reduced from 43.8 kg/m (6.9) at time of MBS to 32.1 kg/m (7.3) at time of KTx. One-year overall survival and death-censored graft survival were 96.4% and 100%, respectively. At median follow-up of 2.7 years, overall survival and death-censored graft survival were 85.7% and 89.3%. A propensity matched analysis revealed no differences in the rates of surgical complications after KTx among those with BS compared to matched controls without MBS. CONCLUSIONS: This study represents the largest single-center series of patients with MBS before KTx. Timing of antecedent BS and type of BS did not impact long-term graft or patient outcomes. Planned MBS with either VSG or RYGB followed by KTx in patients with an initially prohibitive BMI is associated with excellent short- and medium-term outcomes.
BACKGROUND: Excess weight has been linked to leftward QRS axis deviation, but the impact of significant weight loss on cardiac axis remains unclear. OBJECTIVES: To evaluate the association between excess weight loss foll...BACKGROUND: Excess weight has been linked to leftward QRS axis deviation, but the impact of significant weight loss on cardiac axis remains unclear. OBJECTIVES: To evaluate the association between excess weight loss following bariatric surgery and changes in the electrocardiographic cardiac axis. SETTING: Single academic medical center in Brazil. METHODS: Retrospective cohort including patients who underwent bariatric surgery at a multidisciplinary obesity treatment center in Southern Brazil. Pre- and postoperative electrocardiographies (ECGs) were analyzed, with exact cardiac axis determined using the Novosel equation. The main outcome was the association between the percentage of excess weight loss (EWL%) and the change in cardiac axis (Δθ), defined as the difference between the pre- and postoperative cardiac axis values. Multivariable linear regression models were applied, adjusting for time since bariatric surgery. RESULTS: A total of 60 participants (mean age of 42.15 years, 68.3% female) were included. The mean preoperative body mass index was 42.9 ± 6.2 kg/m, decreasing to 28.9 ± 5.2 kg/m postoperatively, with an average EWL% of 66.7 ± 16%. The mean cardiac axis shifted from 27.99 ± 30.77 degrees preoperatively to 42.37 ± 34.06 degrees postoperatively (Δθ = 14.38 ± 26.61 degrees). A 1% increase in EWL% was associated with a .44-degree increase in the cardiac axis (B = .44; 95% confidence interval [CI]: .15-.80; P = .009). CONCLUSIONS: Weight loss following bariatric surgery is associated with changes in the electrocardiographic cardiac axis, with a trend toward rightward shifts. The clinical significance of these findings remains uncertain, and further studies are needed to confirm and clarify the prognostic value of these electrocardiographic adaptations.
BACKGROUND: Sleeve gastrectomy is the most common bariatric procedure, and leaks from the staple line is a difficult complication to manage. Investigation into optimal nutritional support during this management is poorly...BACKGROUND: Sleeve gastrectomy is the most common bariatric procedure, and leaks from the staple line is a difficult complication to manage. Investigation into optimal nutritional support during this management is poorly studied. OBJECTIVE: The purpose of this study was to determine which supplemental nutritional group, enteral or parenteral, achieved superior nutritional outcomes. SETTING: Quaternary care center. METHODS: An IRB approved, retrospective review of a prospectively maintained database, identified patients who had a sleeve gastrectomy leak. We included patients who underwent endoluminal vacuum therapy for leak management. Patients were assigned to 3 cohorts based on their nutritional support: enteral, parenteral, or both. Primary endpoints included nutrition days, % kilocalories met, and % protein met. Secondary endpoints focused on albumin levels. RESULTS: A total of 28 patients (7 male, 21 female) met the inclusion criteria for the study. Five patients received enteral nutrition, 11 patients received parenteral nutrition, and 12 patients received both. Patients who received parenteral nutrition met their daily kcal and protein goals unlike patients who received enteral nutrition (97.4%% versus 55.4%, P < .01, and 105.9% versus 58.7%, P < .01, respectively). Patients who received parenteral nutrition showed an upward trend with their serum albumin levels from day 0 (3.24, 95% CI, 2.93-3.54) to Day 20 (3.34, 95%CI, 2.96-3.72). CONCLUSION: Parenteral nutrition met superior goals compared to enteral nutrition. Additionally, parenteral nutrition serum albumin levels were consistently higher than enteral nutrition. Patients undergoing endoscopic therapy for gastric sleeve leak management may experience greater benefits with parenteral nutrition.
BACKGROUND: Limited data exist on employment outcomes following metabolic and bariatric surgery (MBS), and no studies have specifically evaluated outcomes among patients unemployed specifically due to disability at the t...BACKGROUND: Limited data exist on employment outcomes following metabolic and bariatric surgery (MBS), and no studies have specifically evaluated outcomes among patients unemployed specifically due to disability at the time of surgery. OBJECTIVES: To assess the impact of MBS on return to work (RTW) among patients who were unemployed due to disability preoperatively. SETTING: Academic medical center in the United States. METHODS: A prospectively maintained MBS database was used to identify patients with known preoperative employment status, age 18-59, who underwent primary MBS between 2006 and 2022. Employment status was extracted from the medical record to identify patients unemployed due to disability. The overall RTW was evaluated using Kaplan-Meier analysis and compared between demographic groups using LogRank tests. RESULTS: Of the 6534 eligible patients, 9.6% (n = 625) self-reported as not working due to disability during the preoperative period. The rate of self-reported RTW was 10.5%, 17%, 44.3%, at 2, 4, and 10 years respectively. The median follow-up was 5.7 years. Younger age (P = .026) and private insurance (P = .0043) were associated with increased rates of RTW. CONCLUSION: More than 40% of patients unemployed due to disability returned to work within 10 years of MBS, with nearly 60% of patients under age 40 returning to work within 10 years. These findings suggest MBS may support long-term functional recovery and socioeconomic reintegration among disabled individuals.
Kerver GA, Steffen KJ, Forester G
… +6 more, Laam LA, Chen S, Vogels E, Sarwer DB, Wonderlich SA, Engel SG
Surg Obes Relat Dis
· 2026 Jan · PMID 41047295
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BACKGROUND: Hypoglycemia (i.e., low blood glucose) is a potential complication following metabolic and bariatric surgery (MBS) that can ultimately result in severe and deadly consequences. However, the symptoms typically...BACKGROUND: Hypoglycemia (i.e., low blood glucose) is a potential complication following metabolic and bariatric surgery (MBS) that can ultimately result in severe and deadly consequences. However, the symptoms typically associated with hypoglycemia (e.g., dizziness, anxiety) can be nonspecific, which impairs effective monitoring. OBJECTIVES: This study utilized a unique combination of naturalistic assessments to compare the subjective self-report of hypoglycemic symptoms measured via ecological momentary assessment (EMA) with objectively-collected data from continuous glucose monitoring (CGM). SETTING: Private Hospital, United States. METHODS: Participants were 44 adults who completed 10 days of EMA and CGM 1 year after undergoing Roux-en-Y gastric bypass. Multiple times per day during the EMA protocol, participants identified how many of 18 hypoglycemic symptoms they had experienced since they were last signaled several hours earlier. RESULTS: CGM data showed that ∼66% of participants experienced at least one possible daytime hypoglycemic event (range = 1-23 episodes/person). The total number of hypoglycemic symptoms endorsed via EMA did not correspond with the occurrence of a possible hypoglycemic event captured by CGM (P = .145). However, multilevel models revealed that participants were more likely to report feeling "shaky", "lightheaded", and "coordination problems/clumsiness" (false discovery rate corrected P values < .05) during periods of time coinciding with possible hypoglycemic events identified by CGM. CONCLUSIONS: Many patients are at risk for low blood glucose post-MBS. In the absence of objective assessment, several subjective symptoms may serve as indicators of possible hypoglycemic events following MBS.
BACKGROUND: Nutritional deficiencies are frequent after metabolic and bariatric surgery (MBS) and systematic addition of vitamin B12, iron, calcium, and vitamin D to standard multivitamin tablets is recommended. However,...BACKGROUND: Nutritional deficiencies are frequent after metabolic and bariatric surgery (MBS) and systematic addition of vitamin B12, iron, calcium, and vitamin D to standard multivitamin tablets is recommended. However, there are still uncertainties because supporting data are few and compliance with a large number of tablets is low. OBJECTIVES: To assess the need for additional supplements using a supplementation based on biological assays after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). METHODS: Consecutive patients (N = 313: 179 RYGB/134 SG; 86% women, mean age 44.1 ± 10.3 years, Body mass index 43.5 ± 6.6 kg/m) who underwent a nutritional assessment, before and at 6, 12, and 36 months after MBS, were studied. Multivitamin tablets were systematically prescribed after MBS, and additional supplements were introduced following a standardized protocol in the case of deficiency. SETTING: University Hospital, France. RESULTS: Although the number of patients taking additional supplements increased by more after RYGB than after SG (58.7% vs 43.3%, P < .01), the mean number of deficits did not increase and was similar at 3 years (3.7 vs 3.4, Ns). The frequency of nutritional symptoms was also similar after both procedures, the most common being hair loss, while neurological symptoms were unusual and mild. Anemia was infrequent, but secondary hyperparathyroidism was frequent after RYGB (23% vs 9% after SG, P < .01). CONCLUSIONS: A personalized supplementation strategy adapted to biological parameters, in patients followed regularly up to 3 years after MBS, may reduce the number of nutritional supplements without increasing the number of deficiencies. However, vigilance must be maintained, particularly regarding bone and neurological risks.
BACKGROUND: Reproductive-aged women constitute a substantial proportion of patients undergoing weight loss procedures. Little is known regarding reproductive health outcomes among women after sleeve gastrectomy (SG). OBJ...BACKGROUND: Reproductive-aged women constitute a substantial proportion of patients undergoing weight loss procedures. Little is known regarding reproductive health outcomes among women after sleeve gastrectomy (SG). OBJECTIVE: We aim to explore reproductive health patterns and outcomes after SG. SETTING: University hospital. METHODS: A cross-sectional study performed among reproductive-aged women who underwent SG at a university hospital. Women were surveyed using a questionnaire developed as a collaborative, multidisciplinary effort of a maternal-fetal medicine expert, general gynecologist, and a bariatric surgeon. RESULTS: Overall, 1030 women of childbearing age (median 34 years) underwent SG at our center during the study period. Of them, 928 women completed the questionnaire (response rate of 90%) with a median follow-up duration of 8.4 years. Menstrual irregularity rate (11.9% vs. 43.5%, P < .001) and duration of menstrual bleeding (median 5 vs. 6 days, P < .001) were significantly reduced after surgery as compared to preoperatively. Only 632 (68.1%) women received contraceptive advice perioperatively, with oral contraception being the most commonly used method following surgery (n = 322, 34.7%). Most women (n = 867, 93.4%) received a recommendation to delay conception after surgery, however, 65 (7.5%) women were sexually active in the first year postoperatively without using any mode of contraception. Overall, 301 (32.4%) women delivered after surgery, with pregnancy reported as unintended by 22 (7.3%) women, most of them (n = 14) using oral contraception. CONCLUSIONS: Menstrual cycle pattern significantly improves after SG. Adequate reproductive-health counseling is important after SG in order to inform optimal contraceptive care and potentially prevent unintended pregnancies particularly in the early period after surgery.
BACKGROUND: The Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP) risk/benefit calculator is an important tool used to counsel patients and predict postoperative risk and outcomes after...BACKGROUND: The Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP) risk/benefit calculator is an important tool used to counsel patients and predict postoperative risk and outcomes after bariatric surgery. OBJECTIVES: We aimed to assess the accuracy of the calculator in predicting outcomes after revisional bariatric procedures compared with primary procedures. SETTING: Single-institution and national data. METHODS: Postoperative outcomes (30-day complications and body mass index [BMI] at 6 months and 1 year) of patients undergoing primary and revisional bariatric procedures between 2016 and 2021 were recorded and compared with the predictions of the online calculator. Receiver operating characteristic curves were constructed to assess the predictive utility for binominal outcomes. For BMI, predictive error (predicted - actual BMI) was calculated. We also queried the MBSAQIP participant use files between 2021 and 2022 to examine the calculator use nationally. RESULTS: Out of 1026 patients, 864 (84.2%) had primary, and 162 (15.8%) had revisional bariatric surgery. The area under the curve for any complication, serious complications, surgical site infections (SSIs), and readmissions were .63, .74, .67, and .52 for primary procedures, and .61, .73, .52, and .57 for revisions. The correlation coefficient of predicted and observed 1-year BMI was .74, P < .001 for primary procedures, and .55, P < .001 for revisions. The mean predictive error for 1-year BMI for revisions was higher than that for primary procedures (-3.8 ± 5.2 vs. -.30 ± 4.3, P < .001) with 75% of revisions having a negative predictive error. At the national level, the calculator was used in 18.4% of primary procedures and 16.1% (P < .001) of revisions. CONCLUSIONS: The MBSAQIP calculator is being used to counsel patients undergoing primary and revisional bariatric surgery. While calculator predictions for some outcomes are similar between primary and revisional cases, they are inaccurate for SSIs and weight loss outcomes after revisional surgeries. The development of a revision-specific calculator that provides more accurate estimates is recommended.