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Langenbeck's Archives of Surgery

, Volume 402, Issue 8, pp 1263–1270 | Cite as

Laparoscopic reversal of mini-gastric bypass to original anatomy for severe postoperative malnutrition

  • Laurent GenserEmail author
  • Antoine Soprani
  • Malek Tabbara
  • Jean-Michel Siksik
  • Jean Cady
  • Sergio Carandina
How-I-Do-It Articles

Abstract

Purpose

Malnutrition after mini-gastric bypass (MGB) is a rare and dreaded complication with few data available regarding its surgical management. We aim to report the feasibility, safety, and results of laparoscopic reversal of MGB to normal anatomy (RMGB) in case of severe and refractory malnutrition syndrome after intensive nutritional support (SRMS).

Methods

A 10-year retrospective chart review was performed on patients who underwent RMGB (video included) for SRMS following MGB.

Results

Twenty-six of 2934 patients underwent a RMGB at a mean delay of 20.9 ± 13.4 months post-MGB. At presentation, mean body mass index (BMI), excess weight loss (%EWL), and albumin serum level were 22 ± 4.4 kg/m2, 103.6 ± 22.5%, and 25.5 ± 3.6 gr/L, respectively. Seventeen (63.5%) patients had at least one severe malnutrition related complication including severe edema in 13 (50%), venous ulcers in 2 (7.7%), infectious complications in 7 (27%), deep venous thrombosis in 5 (19.2%), and motor deficit in 5 (19.2%) patients. At surgical exploration, 8 of 12 (66.5%) patients had a biliary limb longer than 200 cm and 9 (34.6%) had bile reflux symptoms. Overall morbidity was 30.8% but lower when resecting the entire previous gastrojejunostomy with creation of a new jejunojejunostomy (8.3 vs 50%, p = 0.03). After a mean follow-up of 8 ± 9.7 months, all patients experienced a complete clinical and biological regression of the SRMS after the RMGB despite a mean 13.9 kg weight regain in 16 (61.5%) patients.

Conclusions

Post-MGB SRMS and its related comorbidities are rare but dreaded conditions. Although burdened by a significant postoperative morbidity and weight regain, RMGB remains an effective option to consider, when intensive nutritional support fails.

Keywords

MGB Mini-bypass Bariatric surgery One anastomosis gastric bypass OAGB Protein Malnutrition Reversal; complication 

Notes

Authors’ contributions

Study conception and design: LG/SC/AS/MT/JMS/JC. Acquisition of data: AS/JC. Analysis and interpretation of data: LG/SC/MT/AS. Drafting of manuscript: LG/SC/MT/AS. Critical revision of manuscript: LG/SC/AS/MT/JMS/JC

Compliance with ethical standards

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

Funding information

None

Conflict of interest

The authors declare that they have no conflict of interest.

Permissions

None

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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Laurent Genser
    • 1
    Email author
  • Antoine Soprani
    • 2
  • Malek Tabbara
    • 3
  • Jean-Michel Siksik
    • 1
  • Jean Cady
    • 2
  • Sergio Carandina
    • 4
  1. 1.Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Hepato-Pancreato-Biliary Surgery, Liver Transplantation, Pitié-Salpêtrière University HospitalPierre & Marie Curie UniversityParisFrance
  2. 2.Department of digestive surgery, Générale de Santé (GDS)Clinique Geoffroy-Saint HilaireParisFrance
  3. 3.Division of Bariatric Surgery, Department of Surgery, Hôpital du Sacré-CoeurUniversity of MontrealMontrealCanada
  4. 4.Centre Chirurgical de l’ObésitéClinique Saint MichelToulonFrance

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