Background. Obesity is well known for being associated with significant economic repercussions. Bariatric surgery is the only evidence-based solution to this problem as well as a cost-effective method of addressing the concern. Numerous authors have calculated the cost effectiveness and cost savings of bariatric surgery; however, to date the economic impact of weight regain as a component of overall cost has not been addressed. Methods. The literature search was conducted to elucidate the direct costs of obesity and primary bariatric surgery, the rate of weight recidivism and surgical revision, and any costs therein. Results. The quoted cost of obesity in Canada was $2.0 billion–$6.7 billion in 2013 CAD. The median percentage of bariatric procedures that fail due to weight gain or insufficient weight loss is 20% (average: , range: 5.2–39, ). Revision of primary surgeries on average ranges from 2.5% to 18.4%, and depending on the procedure accounts for an additional cost between $14,000 and $50,000？USD per patient. Discussion. There was a significant deficit of the literature pertaining to the cost of revision surgery as compared with primary bariatric surgery. As such, the cycle of weight recidivism and bariatric revisions has not as of yet been introduced into any previous cost analysis of bariatric surgery. 1. Background Obesity has been established as a global economic burden. Several countries have already quantified the costs associated with obesity on their healthcare systems, and unequivocally bariatric surgery has been found to be a cost-effective method for reducing obesity related costs and increasing quality of life [1–4]. However, the literature has investigated neither the cost of procedure failure rate due to weight regain or insufficient weight loss, nor the cost burden of patients returning to their original obesity status. The rate of weight regain has been reported as ranging from 5 to 39% corresponding to a median of 20% (average: 21.1% ± 10.1%, range: 5.2–39, ) [5–14]. Several authors have attributed this phenomenon to mechanical failure, such as pouch and stoma dilation, while others believe that the behavioural component is the main contributor to weight gain over time [8, 15, 16]. Weight recidivism can be dealt with via two facets: the patient can remain obese or an attempt at surgical revision can be undertaken. Revision can include band removal, band replacement, conversion to sleeve gastrectomy or gastric bypass, gastric bypass limb lengthening, and endoscopic techniques, each of which has an associated cost and complication
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