Original article Trends in revisional bariatric surgery using the MBSAQIP database 2015-2017 Benjamin Clapp, M.D., F.A.C.S., F.A.S.M.B.S * , Brittany Harper, M.S, Christopher Dodoo, M.S, William Klingsporn, M.D, Ashtyn Barrientes, Michael Cutshall, M.D, Alan Tyroch, M.D., F.A.C.S Department of Surgery, Texas Tech Health Sciences Center, Paul Foster School of Medicine, El Paso, Texas Received 5 November 2019; accepted 3 March 2020 Abstract Background: The third most common bariatric surgery is revisional bariatric surgery. The American College of Surgeons tracks outcomes using the Metabolic and Bariatric Surgery Accreditation Qual- ity Initiative Program database. We used this database to examine trends in revisional bariatric surgery. Objective: To evaluate how trends in bariatric revisional surgery have changed in recent years. Setting: University Hospital, United States. Methods: The Metabolic and Bariatric Surgery Accreditation Quality Initiative Program database for 2015 to 2017 was examined for revisions of bariatric surgery. Patients who underwent revisional bariatric surgery were identified by the primary Current Procedural Terminology code, the REVCONVand PREVIOUS_SURGERY field as well as secondary Current Procedural Terminology codes. There is no exact code for sleeve gastrectomy (SG) to laparoscopic Roux-en-Y gastric bypass (LRYGB), so we used 43644 (GB)1REVCONV1PREVIOUS_SURGERY for this. Results: For the years 2015 to 2017 there were 57,683 revisions/conversions of 528,081 pa- tients. The number of revisions increased over the study period by 5213 cases. The most com- mon revision was laparoscopic adjustable gastric band (LAGB) to SG with 15,433 cases and the second was LAGB to LRYGB with 10,485 cases. There were 14,715 LAGB removals. It is more difficult to track SG to LRYGB but there were 8491 unlisted cases, which may have been sleeve to bypass. Conclusion: LAGBs are being taken out or converted, and this group makes up the largest portion of revisions and conversions. It is difficult to track SG to LRYGB, but the number of unlisted cases con- tinues to climb. This will likely surpass LAGB conversions with time. The Metabolic and Bariatric Surgery Accreditation Quality Initiative Program should be modified to capture revisions/conver- sions of SG. (Surg Obes Relat Dis 2020;16:908–915.) Ó 2020 American Society for Bariatric Sur- gery. Published by Elsevier Inc. All rights reserved. Key words: Bariatric surgery; Revisional bariatric surgery; MBSAQIP; Metabolic and Bariatric Surgery Accreditation and Quality Improvement There has been a leveling off in the volume of bariatric procedures for the last 5 years [1]. As the number of gastric bypasses (LRYGB) and sleeve gastrectomies (SG) stabilize, an increase in revisions of bariatric surgery has been *Correspondence: Benjamin Clapp, M.D., F.A.S.M.B.S., 1700 N. Mesa, El Paso, TX 79902. E-mail address: b_clapp1@hotmail.com (B. Clapp). https://doi.org/10.1016/j.soard.2020.03.002 1550-7289/Ó 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved. Surgery for Obesity and Related Diseases 16 (2020) 908–915