N. R. Changoor1, G. Ortega1, J. Kendall2, C. M. Smith2, K. Hughes1, T. M. Fullum1, D. Tran1 1Howard University College Of Medicine,Department Of Surgery,Washington, DC, USA 2Howard University College Of Medicine,Washington, DC, USA
Introduction:
Roux-en-Y gastric bypass (RYGB) is well known to be effective for the morbidly obese population. However, weight regain continues to be a significant problem for many patients. We report the outcomes of revision of RYGB to distal RYGB (DRYGB) in patients suffering from weight regain following their original procedure.
Methods:
A review of prospectively collected data was performed at a tertiary urban teaching hospital. Over a four-year period between March 2012 and March 2017, 21 patients underwent laparoscopic revision of RYGB to DRYGB. At the time of the original RYGB, the mean weight and body mass index (BMI) were 324.4 ± 60.8 lbs. and 52.2 ± 8.2 kg/m2, respectively. The interval between the original procedure and the revision was 120.1 ± 61.2 months. Patients regained on average 70.2 ± 41.8 lbs, or a BMI gain of 11.4 ± 6.7 kg/m2. The mean weight at the time of revision was 277.5 ± 54.8 lbs. (BMI of 44.7 ± 6.9 kg/m2). All patients suffered from one or more obesity-related comorbidities.
Results:
The mean operative time was 157.4 ± 30.8 minutes. All patients were discharged on post-operative day 1, except for two who were discharged on post-operative day 2. There were no complications or mortalities within 30 days of surgery. The average weight (BMI) were 229.4 ± 53.6 lbs. (37.0 ± 6.0 kg/m2) at six months, 215.5 ± 46.5 lbs. (34.4 ± 5.8 kg/m2) at one year, 205.2 ± 28.9 lbs., (34.3 ± 4.0 kg/m2) at two years, 184.5 ± 44.9 lbs. (29.1 ± 7.5 kg/m2) at three years, and 177.4 +-42.6 lbs (27.9 +- 6.2 kg m/m2) at 4 years. We used percent excess BMI loss (%EBMIL) calculated as follows: (BMI at revision – BMI at 4 years)/(BMI at revision – ideal BMI) x 100. The %EBMIL at four years was 74.7 ± 35.2%. Four patients (19%) suffered from protein calorie malnutrition following the procedure, of which two required reversal. One patient died at four years from severe protein calorie malnutrition because of failure to follow up. Another patient, who was not malnourished, required reversal due to ischemic bowel secondary to adhesive bowel obstruction. Using paired t-test, significant difference was found between the BMI at revision and the BMI at four years post revision (p = .02).
Conclusion:
The options of surgical revision are limited for patients who regained weight after RYGB. In spite of higher risks of long term malnutrition, laparoscopic revision to DRYGB remains an effective procedure for these patients.