Laparoscopic reversal of mini-gastric bypass to original anatomy for severe postoperative malnutrition
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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).
A 10-year retrospective chart review was performed on patients who underwent RMGB (video included) for SRMS following MGB.
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.
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.
KeywordsMGB Mini-bypass Bariatric surgery One anastomosis gastric bypass OAGB Protein Malnutrition Reversal; complication
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.
Conflict of interest
The authors declare that they have no conflict of interest.
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