Revision of Roux-en-Y Gastric Bypass for Inadequate Weight Loss or Weight Regain

Abstract

Inadequate weight loss or weight regain after Roux-en-Y gastric bypass (RYGBP) occurs in more than a quarter of patients for various reasons. Available remedying treatment options include endoscopic and surgical techniques for revision of the gastric pouch and the gastrojejunal anastomosis, conversion of standard to distal gastric bypass (DRYGBP) or the conversion of RYGBP to biliopancreatic diversion (BPD) or duodenal switch (DS).There is quite a variability concerning the technical simplicity, safety, and effectiveness of these techniques and the small number of patients in the numerous single-center reports precludes any meaningful comparisons. This review aimed to describe all available methods and present the advantages and disadvantages of each of them, to facilitate, rather than guide, the decision of the average bariatric surgeon who encounters such a patient.

Surgical Treatment of Obesity. Special Mention to Roux-en-Y Gastric Bypass and Vertical Gastrectomy

“…The mechanisms of action include mechanical restriction of ingested calories due to the small gastric pouch, mild malabsorption due to the bypassing of a reasonable portion of the jejunum, and hormonal changes ensuing from the two latter, like reduction of the production of ghrelin from the excluded gastric fundus, early secretion of peptide YY(PYY) from the distal ileum and changes in the levels of various incretins such as GLP1 (43).…”

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?

“…The placement of a gastric banding at the level of the dilated gastric pouch appears to be effective in restoring the restrictive component, with encouraging weight loss results in the short and medium term [ 8 , 9 ]. Unfortunately, the complications traditionally described for this device, such as reflux, dysphagia, and slippage, have in several series led to a high rate of removal of the banding [ 12 ]. Vilallonga et al proposed returning to normal anatomy with a sleeve gastrectomy in a single step as an option after WR [ 7 ].…”

“…In these cases, treatment options are limited, and literature data are scarce [ 6 ]. During the last few years, returning to normal anatomy with a sleeve gastrectomy (LSG) and the placement of an adjustable gastric band at the gastric pouch level in order to restore the restrictive component of the bypass have been proposed, with debatable results [ 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. A third option proposed with the same aim is the laparoscopic resizing of the gastric pouch (LPR), with or without the narrowing of the GJA.…”

Surgical techniques in bariatric surgery: minimally invasive approaches and long-term outcomes

“…The fact that the procedure can offer short-term weight loss only guarantees sustained results if it braces healthy eating, exercises, and regular follow-ups with the doctor. 24 Patients must be open to these mutations to realize the numerous benefits of the revision expeditiously. However, different from insurance policies that support some weight loss procedures, the revision and services of gastric bypass may not be covered.…”