Obesity Surgery

, Volume 22, Issue 11, pp 1746–1754

Outcomes of Revisional Procedures for Insufficient Weight Loss or Weight Regain After Roux-En-Y Gastric Bypass

  • Jacques Himpens
  • Laia Coromina
  • Anneleen Verbrugghe
  • Guy-Bernard Cadière
Clinical Research

DOI: 10.1007/s11695-012-0728-7

Cite this article as:
Himpens, J., Coromina, L., Verbrugghe, A. et al. OBES SURG (2012) 22: 1746. doi:10.1007/s11695-012-0728-7

Abstract

Background

The Roux-en-Y gastric bypass (RYGB) performed laparoscopically (LRYGB) is the most frequently performed bariatric procedure in Belgium. However, late results in terms of weight loss or weight regain are inconsistent and may warrant a second procedure. This retrospective study analyzes the laparoscopic options for revisional surgery after LRYGB.

Methods

Between January 1, 2001 and December 31, 2009, 70 patients underwent a new laparoscopic procedure for poor weight loss or weight regain after LRYGB. The revisional procedure was performed a median of 2.6 years after the initial bypass operation. Fifty-eight patients were available for follow-up (82.9 %); 19 underwent distalization; and 39 a new restrictive procedure.

Results

The mean mass index (BMI) before the revisional procedure was 39.1 + 11.3 kg/m2 (30.8–51.8), down from 42.7 + 19.7 kg/m2 (33.0–56.6) initially, which corresponded to a percentage of excess weight loss (EWL) of 12.4 + 9.3 % (−1.0–29.1). After the corrective procedure, with a follow-up of approximately 4 years, mean BMI was 29.6 + 12.4 kg/m2 (18.0–45.5), for a significant additional percentage of EWL of 53.7 + 9.8 % (2.0–65.8). The overall complication rate was 20.7 %, and the reoperation rate was 7.3 %. The overall leak rate was 12.1 %. Patients suffering from leaks could consistently be treated conservatively or by stent placement. Two patients needed reconversion after distal bypass. The satisfaction index was good in just over 50 % of the patients.

Conclusion

Revisional laparoscopic surgery after RYGB performed for weight issues provides good additional weight loss but carries significant morbidity. Leaks can usually be handled non-surgically. Patient satisfaction is only fair.

Keywords

Laparoscopic Roux-en-Y gastric bypass Revisional surgery Weight regain Insufficient weight loss Complications 

Copyright information

© Springer Science + Business Media, LLC 2012

Authors and Affiliations

  • Jacques Himpens
    • 1
  • Laia Coromina
    • 1
  • Anneleen Verbrugghe
    • 1
  • Guy-Bernard Cadière
    • 2
  1. 1.The European School of LaparoscopySt Blasius General HospitalDendermondeBelgium
  2. 2.The European School of LaparoscopySt Pierre University HospitalBrusselsBelgium

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