Pouch Reshaping for Significant Weight Regain After Roux-en-Y Gastric Bypass

Overview

Journal Obes Surg

Date 2016 Aug 12

PMID 27510586

Citations 13

Authors

Yves Borbely

Carmen Winkler

Dino Kroll

Philipp Nett

Affiliations

Soon will be listed here.

Abstract

Background: Significant weight regain after Roux-en-Y gastric bypass (RYGB) occurs in around 20 % of patients in the long term. Anatomical reasons include dilatation of the gastric pouch and/or the pouch-jejunal anastomosis, leading to loss of restriction. Pouch reshaping (PR) aims at reestablishing restriction with a subsequent feeling of satiety. This study reports the outcome of PR embedded in a multidisciplinary treatment pathway.

Methods: Twenty-six patients after PR for weight regain >30 % following RYGB in a university hospital between October 2010 and March 2016 were analyzed. Excluded were patients with PR for gastro-gastric fistulae, hypoglycemia, candy cane syndrome, and concomitant alteration of limb lengths. PR consisted in laparoscopic lateral resection of the gastric pouch, the anastomosis and the proximal 5 cm of the alimentary limb over a 32F bougie.

Results: Median follow-up after PR was 48 months (range 24-60). Median BMI at PR was 39.1 kg/m (32.7-59.1). Median operation time was 85 min (25-190), and median length of stay was 3 days (1-35). Minor complications (grade ≤ 2) occurred in seven (27 %) patients and major complications (grade ≥ 3) in four patients (15 %). Nadir BMI and %EBMIL after PR were 32.9 kg/m and 43.3 %, reached after a median of 12 months (3-48). Comorbidities were resolved in 81 %. After 48 months, median BMI was 33.8 kg/m (20.4-49.2) and %EBMIL was 61.4 (39.1-121.2).

Conclusions: Used selectively in a multidisciplinary treatment pathway, PR leads to prolonged weight stabilization around the previous nadir. However, its associated perioperative morbidity must not be disregarded.

Citing Articles

Gastric Pouch Resizing for Recurrent Weight Gain After Roux-en-Y Gastric Bypass-Does It Have Its Rational?.

Hehl S, Birrer D, Hauser R, Gero D, Thalheimer A, Bueter M Obes Surg. 2024; 34(12):4369-4377.

PMID: 39531140 PMC: 11671430. DOI: 10.1007/s11695-024-07581-y.

Gastric bypass revisional surgery: percentage total body weight loss differences among three different techniques.

Estrada A, Rodriguez-Quintero J, Pereira X, Moran-Atkin E, Choi J, Camacho D Langenbecks Arch Surg. 2024; 409(1):151.

PMID: 38703235 DOI: 10.1007/s00423-024-03342-8.

Convincing 10-Year Follow-up Results of the Banded Roux-en-Y Gastric Bypass.

Jense M, Meuwissen N, Galal A, de Witte E, Fransen S, Broos P Obes Surg. 2024; 34(4):1286-1294.

PMID: 38393455 PMC: 11026224. DOI: 10.1007/s11695-024-07113-8.

Resizing of the Gastric Pouch for Weight Regain after Laparoscopic Roux-en-Y Gastric Bypass and One-Anastomosis Gastric Bypass: Is It a Valid Option?.

Ferro S, Zulian V, De Palma M, Sartori A, Andreica A, Nedelcu M J Clin Med. 2022; 11(21).

PMID: 36362466 PMC: 9659038. DOI: 10.3390/jcm11216238.

Long-Term Results at 10 Years of Pouch Resizing for Roux-en-Y Gastric Bypass Failure.

Drai C, Chierici A, Schiavo L, Mazahreh T, Schneck A, Iannelli A Nutrients. 2022; 14(19).

PMID: 36235686 PMC: 9572516. DOI: 10.3390/nu14194035.

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