Proposal of a Revisional Surgery to Treat Severe Nutritional Deficiency Post-Gastric Bypass

Abstract

Background The gastric bypass has nutritional and electrolyte disturbances rate of approximately 17%. The most common deficits are protein malnutrition, ferric and zinc, in addition to the vitamin. Although rare, some malnutrition stages reach such severity that ends up being necessary hospitalization and sometimes revisional or reversal surgical procedures.Aim: To present a proposal of surgical revision for treatment of severe malnutrition after bariatric surgery.Methods: The procedure is to reconstitute the food transit through the duodenum and proximal jejunum, keeping the gastric bypass restrictive component. As an additional strategy, the gastric fundus resection is performed, aiming to intensify the suppression of the greline and avoiding excessive weight regain.Results: After initial stabilization, nutritional and electrolytic support, the procedure was performed in two patients as definitive treatment of malnutrition status. Good results were observed at one year follow up.Conclusion: As improvement option and/or resolution of the nutritional alterations, surgical therapy is one of the alternatives. There is still no consensus on the surgical technique to be performed. This procedure is based on pathophysiological factors for the treatment of this condition, with good initial results, without significant clinical alterations. Longer follow-up will determine its effectiveness.

Fundoplication Conversion in Roux-en-Y Gastric Bypass for Control of Obesity and Gastroesophageal Reflux: Systematic Review

“…Gastroesophageal reflux disease (GERD) has a prevalence estimated between 20-40% in the USA and Europe and 12% in Brazil 6 , 14 , 15 , 22 . Obesity is a frequently associated condition, due to an increase in abdominal pressure with consequent hypotonia of the lower esophageal sphincter, and increase in the frequency of its spontaneous relaxation 1 , 3 , 5 , 10 , 19 , 20 . The surgical treatment of GERD has regained space with the advent of laparoscopy.…”

Critical Analysis of Surgical Treatment Techniques of Morbid Obesity

“…RYGB is a mixed technique (restrictive and disabsorptive) that presents good results in the treatment of comorbidities and also in the loss of excess weight 19 . Maher et al 17 reported that it should be the one of choice in bariatric surgery, mainly in super obese and diabetic patients.…”

Revisional surgery in severe nutritional complications after bariatric surgical procedures: report of four cases from a single institution and review of the literature

“…With regard to the clinical presentation, patients with severe malnutrition requiring revisional operations, usually have hypoalbuminemia, anemia, renal failure, liver failure, ascites, anasarca, and they require preoperative parenteral nutrition 8,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] .…”

“…Revision procedures (elongation of the common channel) and conversion techniques are mostly associated with malabsorption, such as BPD, BPD with duodenal switch, and distal gastric bypass, into conventional gastric bypass are widely used techniques and they also maintain a metabolic component to prevent obesity relapse. Reversals are obviously chosen in patients with severe malnutrition or those who underwent revisional surgery 8,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] .…”

“…Sampaio-Neto et al 14 described a revisional procedure and were successful in two cases. It consists of anastomosis between the alimentary limb 10 cm from the anterior gastroenterostomy and the gastric antrum 4 cm from the pylorus; the alimentary limb is sectioned distally to the new anastomosis, following the resection of the original enteroanastomosis.…”