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

Shin, Reuben D; Goldberg, Michael B.; Shafran, Allison S; Shikora, Samuel A; Majumdar, Melissa C; Shikora, Scott A.

doi:10.1007/s11695-018-03635-0

Cited by 43 publications

(32 citation statements)

References 40 publications

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“…Ideally, the bowel length must always be measured. There is now enough evidence showing that a long BP limb provides more weight loss and better metabolic effect [31][32][33][34][35][36]. In LPRYGB, the common channel is usually 200 cm and the alimentary limb 100 cm.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Long Pouch Gastric Bypass (LPGB): 4-Year Experience in Primary and Revision Cases

et al. 2019

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Background One of the most important complications of the one anastomosis gastric bypass (OAGB) is enterobilio acid reflux (EBAR). We report the concept of the long pouch Roux-en-Y gastric bypass (LPRYGB) meaning a Roux-en-Y with a long pouch and a 100-cm alimentary limb to avoid EBAR, with a long biliopancreatic limb to increase metabolic effects. Methods A total of 300 LPRYGB cases in a 4-year period, with a 90% follow-up rate, were analysed. Anthropometric, technical feasibility, morbidity, weight loss and comorbidity outcomes were analysed. Results The percentage total weight loss (%TWL) was 30.5% at 4 years of follow-up (32.3% in primary and 28.3% in revisions). Six intra-operative (2%) and 28 postoperative complications (9.3%) were seen. Out of this 28 complications, 11 (3.6%) were late complications. Reoperations were performed in 15 patients (5.0%). Clinically relevant EBAR was present in 3 cases only (1%) 4 years after the operation. Conclusions The LPRYGB combines the main advantages of the OAGB (light restriction and moderate malabsorption) with the anti-reflux effect from the Roux-en-Y diversion.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Long Pouch Gastric Bypass (LPGB): 4-Year Experience in Primary and Revision Cases

et al. 2019

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“…Similar to what was reported in the last study, post-revisional weight loss was accompanied by T2DM remission in three out of four patients and one patient out of six was able to suspend their medication for hypertension. 36 In a retrospective study with 28 patients and a median follow-up of 72 months, BPL lengthening reduced mean pre-revision BMI from 41.7 to 30.1 kg/m 2 . However, a high rate (25%) of Clavien-Dindo greater than III was reported.…”

Section: Laparoscopic Biliopancreatic Limb Lengtheningmentioning

confidence: 97%

Interventions for Weight Regain after Bariatric Surgery

Muñóz

Soto

2021

Digestive Disease Interventions

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Bariatric surgery is the most effective available treatment for obesity, inducing a significant and durable weight loss, and improving several obesity-associated diseases. However, as the number of bariatric surgeries performed increases, so does the prevalence of patients who experience either insufficient weight loss or weight regain, accompanied by relapse or the emergence of new obesity-related diseases. Endoscopic and surgical bariatric revisional procedures are used to promote weight loss and improve metabolic function to address these problems. After a psychological, nutritional, medical, and anatomical evaluation of the gastrointestinal anatomy has been completed, patient candidacy to a revisional procedure must be defined. In those patients with insufficient weight loss or weight regain associated with relapse, the emergence of new obesity-related diseases, or quality-of-life deterioration, a revisional procedure must be selected. Although current evidence comes mainly from observational and retrospective studies, with a limited number of patients and short follow-up times, the available data indicate that revisional procedures are useful to induce a significant weight loss and/or promote remission of obesity-associated diseases, albeit an increased risk of surgical and/or nutritional complications. Thus, careful selection of patients is needed to minimize risk and maximize the benefit of these procedures.

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“…Pretty similar results were also reported by Shin et al after revising 21 patients with inadequate weight loss after RYGBP to distal gastric bypass by taking down the JJ at the end of the alimentary limb and re-anastomosing this Roux limb more distally, thus lengthening the BP limb at the cost of the common channel length. The authors concluded that a common channel length of 200 cm and a cumulative length of 250 cm for the sum of Roux and common channel provided optimal results, both concerning weight loss and avoiding long-term nutritional deficiencies (31).…”

Section: Distalization Of the Jejuno-jejunal Anastomosismentioning

confidence: 99%

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

Alexandrou

Sakarellos

Davakis

et al. 2021

In Vivo

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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.

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

Cited by 43 publications

References 40 publications

Outcomes of Long Pouch Gastric Bypass (LPGB): 4-Year Experience in Primary and Revision Cases

Outcomes of Long Pouch Gastric Bypass (LPGB): 4-Year Experience in Primary and Revision Cases

Interventions for Weight Regain after Bariatric Surgery

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

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