Obesity Surgery

, Volume 21, Issue 8, pp 1289–1295 | Cite as

Laparoscopic Reconversion of Roux-en-Y Gastric Bypass to Original Anatomy: Technique and Preliminary Outcomes

  • Giovanni Dapri
  • Guy Bernard Cadière
  • Jacques Himpens
New Concepts



Laparoscopic Roux-en-Y gastric bypass (RYGB) is one of the most common bariatric procedures performed. Dumping syndrome, intolerance to RYGB-induced restriction, and weight loss issues are possible problems bariatric surgeons are confronted with. This study reports the feasibility, safety, and outcomes of laparoscopic reconversion of RYGB to original anatomy (OA) as treatment of these complications.


Between January 2005 and April 2008, eight patients benefited from laparoscopic reconversion of RYGB to OA. Reason was dumping syndrome without postprandial hypoglycemia (three), intolerance to RYGB-induced restriction (three), too much (one) and too little weight loss (one). Mean weight and body mass index (BMI) at RYGB were 104.7±19.3 kg and 38.7±6 kg/m2, respectively. Four patients suffered of obesity co-morbidities. Mean time between RYGB and reconversion was 21±18.8 months. Mean weight, BMI, and % excess weight loss at reconversion was 66.8±21.7 kg, 20.1±7 kg/m2, and 23.7±55%, respectively. The procedure involved dismantling both gastrojejunostomy and jejunojejunostomy, reanastomosing gastric pouch to gastric remnant, and proximal alimentary limb end to distal biliary limb end.


Mean operative time was 132.2±29.5 min. There were no conversions to open surgery and no early complications. Gastrogastrostomy was performed manually (four) and by linear stapler (four), and jejunojejunostomy by linear stapler (eight). Mean hospital stay was 7.7±3.5 days. After a mean follow-up of 18.3±9.2 months, two patients continued to further lose weight, two patients maintained the same weight, and four patients presented weight regain. Gastroesophageal reflux disease appeared in three patients.


Laparoscopic reconversion of RYGB to OA is feasible and safe. Dumping syndrome and intolerance to RYGB-induced restriction are resolved. The anatomy remains one of the aspects besides nutritional and psychological factors in cases of reconversion for weight issues.


Gastric bypass Complications Conversion Original anatomy Laparoscopy 


  1. 1.
    Pories W, Swanson M, MacDonald K. Who would have thought it? An operation to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339–50.PubMedCrossRefGoogle Scholar
  2. 2.
    Jones K. Experience with the Roux-en-Y gastric bypass, and commentary on current trends. Obes Surg. 2000;10:183–5.PubMedCrossRefGoogle Scholar
  3. 3.
    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.PubMedCrossRefGoogle Scholar
  4. 4.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRefGoogle Scholar
  5. 5.
    Matthews DH, Lawrence Jr W, Poppell JW, et al. Change in effective volume during experimental dumping syndrome. Surgery. 1960;48:185–94.Google Scholar
  6. 6.
    Bikman BT, Zheng D, Pories WJ, et al. Mechanism for improved insulin sensitivity after gastric bypass surgery. J Clin Endocrinol Metab. 2008;93:4656–63.PubMedCrossRefGoogle Scholar
  7. 7.
    Deitel M. The change in the dumping syndrome concept. Obes Surg. 2008;18:1622–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Guijarro A, Kirchner H, Meguid MM. Catabolic effects of gastric bypass in a diet-induced obese rat model. Curr Opin Clin Nutr Metab Care. 2006;9:423–35.PubMedCrossRefGoogle Scholar
  9. 9.
    Himpens J, Dapri G, Cadière GB. Laparoscopic conversion of the gastric bypass into a normal anatomy. Obes Surg. 2006;16:908–12.PubMedCrossRefGoogle Scholar
  10. 10.
    Ukleja A. Dumping syndrome: pathophysiology and treatment. Nutr Clin Pract. 2005;20:517–25.PubMedCrossRefGoogle Scholar
  11. 11.
    Kellogg TA, Bantle JP, Leslie DB, et al. Postgastric bypass hyperinsulinemic hypoglycemia syndrome: characterization and response to a modified diet. Surg Obes Relat Dis. 2008;4:492–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Johnson LP, Sloop RD, Jesseph JE, et al. Serotonin antagonists in experimental and clinical “dumping”. Ann Surg. 1962;156:537–49.PubMedCrossRefGoogle Scholar
  13. 13.
    Peskin GW, Miller LD. The use of serotonin antagonists in postgastrectomy syndromes. Am J Surg. 1965;109:7–13.PubMedCrossRefGoogle Scholar
  14. 14.
    Z’graggen K, Guweidhi A, Steffen R, et al. Severe recurrent hypoglycemia after gastric bypass. Obes Surg. 2008;18:981–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Fernandez-Esparrach G, Lautz DB, Thompson CC. Peroral endoscopic anastomotic reduction improves intractable dumping syndrome in Roux-en-Y gastric bypass patients. Surg Obes Relat Dis. 2010;6:36–40.PubMedCrossRefGoogle Scholar
  16. 16.
    Service GJ, Thompson GB, Service FJ, Andrews JC, Collazo-Clavell ML, Lloyd RV. Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery. N Engl J Med. 2005;353:249–54.PubMedCrossRefGoogle Scholar
  17. 17.
    Patti ME, McMahon G, Mun EC, et al. Severe hypoglycemia post-gastric bypass requiring partial pancreatectomy: evidence for inappropriate insulin secretion and pancreatic islet hyperplasia. Diabetologia. 2005;48:2236–40.PubMedCrossRefGoogle Scholar
  18. 18.
    Parikh M, Pomp A, Gagner M. Laparoscopic conversion of failed gastric bypass to duodenal switch: technical considerations and preliminary outcomes. Surg Obes Relat Dis. 2007;3:611–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Escalona A, Devaud N, Perez G, et al. Antecolic versus retrocolic alimentary limb in laparoscopic Roux-en-Y gastric bypass: a comparative study. Surg Obes Relat Dis. 2007;4:423–7.CrossRefGoogle Scholar
  20. 20.
    Champion JK, Williams M. Small bowel obstruction and internal hernias after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13:596–600.PubMedCrossRefGoogle Scholar
  21. 21.
    Klaus A, Gruber I, Wetscher G, et al. Prevalent esophageal body motility disorders underlie aggravation of GERD symptoms in morbidly obese patients following adjustable gastric banding. Arch Surg. 2006;141:247–51.PubMedCrossRefGoogle Scholar
  22. 22.
    Korbonits M, Blaine D, Elia M, Powell-Tuck J. Metabolic and hormonal changes during the refeeding period of prolonged fasting. Eur J Endocrinol. 2007;157:157–66.PubMedCrossRefGoogle Scholar
  23. 23.
    Gariballa S. Refeeding syndrome: a potentially fatal condition but remains underdiagnosed and undertreated. Nutrition. 2008;24:604–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Rutledge T, Groesz LM, Savu M. Psychiatric factors and weight loss patterns following gastric bypass surgery in a veteran population. Obes Surg 2009. doi:10.007/511695-009-9923-6.

Copyright information

© Springer Science + Business Media, LLC 2010

Authors and Affiliations

  • Giovanni Dapri
    • 1
  • Guy Bernard Cadière
    • 1
  • Jacques Himpens
    • 1
  1. 1.Department of Gastrointestinal Surgery European School of Laparoscopic Surgery Saint-Pierre University HospitalBrusselsBelgium

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