Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

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/m2 (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/m2 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/m2 (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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Brethauer SA, Kothari S, Sudan R, et al. Systematic review on reoperative bariatric surgery: American Society for Metabolic and Bariatric Surgery Revision Task Force. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2014;10:952–72.

    Article  Google Scholar 

  2. Sjostrom L. Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273:219–34.

    Article  CAS  PubMed  Google Scholar 

  3. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25:1822–32.

    Article  CAS  PubMed  Google Scholar 

  4. Karmali S, Brar B, Shi X, et al. Weight recidivism post-bariatric surgery: a systematic review. Obes Surg. 2013;23:1922–33.

    Article  PubMed  Google Scholar 

  5. Peterli R, Borbely Y, Kern B, et al. Early results of the Swiss Multicentre Bypass or Sleeve Study (SM-BOSS): a prospective randomized trial comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Ann Surg. 2013;258:690–4 .discussion 695

    Article  PubMed  PubMed Central  Google Scholar 

  6. Christou NV, Look D, Maclean LD. Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg. 2006;244:734–40.

  7. Magro DO, Geloneze B, Delfini R, et al. Long-term weight regain after gastric bypass: a 5-year prospective study. Obes Surg. 2008;18:648–51.

    Article  PubMed  Google Scholar 

  8. Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.

    Article  PubMed  Google Scholar 

  9. Cooper TC, Simmons EB, Webb K, et al. Trends in weight regain following Roux-en-Y gastric bypass (RYGB) bariatric surgery. Obes Surg. 2015;25:1474–81.

    Article  PubMed  Google Scholar 

  10. Nicoletti CF, de Oliveira BA, de Pinhel MA, et al. Influence of excess weight loss and weight regain on biochemical indicators during a 4-year follow-up after Roux-en-Y gastric bypass. Obes Surg. 2015;25:279–84.

    Article  PubMed  Google Scholar 

  11. Noah J Switzer MAD. (2014) Roux en Y gastric bypass: how and why it fails? Surg: Curr Res 04

  12. Heneghan HM, Yimcharoen P, Brethauer SA, et al. Influence of pouch and stoma size on weight loss after gastric bypass. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2012;8:408–15.

    Article  Google Scholar 

  13. Iannelli A, Schneck AS, Hebuterne X, et al. Gastric pouch resizing for Roux-en-Y gastric bypass failure in patients with a dilated pouch. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2013;9:260–7.

    Article  Google Scholar 

  14. Borbely Y, Plebani A, Kroll D, et al. (2015) Exocrine pancreatic insufficiency after Roux-en-Y gastric bypass. Surgery for obesity and related diseases: official journal of the American Society for Bariatric Surgery

  15. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Roberts K, Duffy A, Kaufman J, et al. Size matters: gastric pouch size correlates with weight loss after laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2007;21:1397–402.

    Article  CAS  PubMed  Google Scholar 

  17. Muller MK, Wildi S, Scholz T, et al. Laparoscopic pouch resizing and redo of gastro-jejunal anastomosis for pouch dilatation following gastric bypass. Obes Surg. 2005;15:1089–95.

    Article  PubMed  Google Scholar 

  18. Parikh M, Heacock L, Gagner M. Laparoscopic “gastrojejunal sleeve reduction” as a revision procedure for weight loss failure after roux-en-y gastric bypass. Obes Surg. 2011;21:650–4.

    Article  PubMed  Google Scholar 

  19. Hamdi A, Julien C, Brown P, et al. Midterm outcomes of revisional surgery for gastric pouch and gastrojejunal anastomotic enlargement in patients with weight regain after gastric bypass for morbid obesity. Obes Surg. 2014;24:1386–90.

    Article  PubMed  Google Scholar 

  20. Schwartz RW, Strodel WE, Simpson WS, et al. Gastric bypass revision: lessons learned from 920 cases. Surgery. 1988;104:806–12.

    CAS  PubMed  Google Scholar 

  21. Flanagan L. Measurement of functional pouch volume following the gastric bypass procedure. Obes Surg. 1996;6:38–43.

    Article  CAS  PubMed  Google Scholar 

  22. Mason EE, Printen KJ, Hartford CE, et al. Optimizing results of gastric bypass. Ann Surg. 1975;182:405–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Bjorklund P, Laurenius A, Een E, et al. Is the Roux limb a determinant for meal size after gastric bypass surgery? Obes Surg. 2010;20:1408–14.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Himpens J, Coromina L, Verbrugghe A, et al. Outcomes of revisional procedures for insufficient weight loss or weight regain after Roux-en-Y gastric bypass. Obes Surg. 2012;22:1746–54.

    Article  PubMed  Google Scholar 

  25. Cook CM, Edwards C. Success habits of long-term gastric bypass patients. Obes Surg. 1999;9:80–2.

    Article  CAS  PubMed  Google Scholar 

  26. Steffen R, Potoczna N, Bieri N, et al. Successful multi-intervention treatment of severe obesity: a 7-year prospective study with 96 % follow-up. Obes Surg. 2009;19:3–12.

  27. Dakin GF, Eid G, Mikami D, et al. Endoluminal revision of gastric bypass for weight regain—a systematic review. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2013;9:335–42.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, 3010, Bern, Switzerland

    Yves Borbély, Carmen Winkler, Dino Kröll & Philipp Nett

Authors
  1. Yves Borbély
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carmen Winkler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dino Kröll
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Philipp Nett
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yves Borbély.

Ethics declarations

The study was approved by the local medical ethics committee.

Conflicts of Interest

The authors declare that they have no conflict of interest.

Formal Consent

For this type of study, formal consent is not required.

Informed Consent

For this type of study, informed consent was not required. No identifying details are present.

Funding

No external funding.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Borbély, Y., Winkler, C., Kröll, D. et al. Pouch Reshaping for Significant Weight Regain after Roux-en-Y Gastric Bypass. OBES SURG 27, 439–444 (2017). https://doi.org/10.1007/s11695-016-2329-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-016-2329-3

Keywords

Search

Navigation