Obesity Surgery

, Volume 24, Issue 8, pp 1386–1390 | Cite as

Midterm Outcomes of Revisional Surgery for Gastric Pouch and Gastrojejunal Anastomotic Enlargement in Patients with Weight Regain After Gastric Bypass for Morbid Obesity

  • Abdulrahman Hamdi
  • Christopher Julien
  • Phillip Brown
  • Ian Woods
  • Anas Hamdi
  • Gezzer Ortega
  • Terrence Fullum
  • Daniel Tran
Original Contributions

Abstract

Reoperative surgery for the morbidly obese has become increasingly common due to postoperative weight regain. There are limited studies evaluating the effectiveness of revisional surgery. This study evaluates the weight loss outcomes of revisional surgery over a 2-year period at our University Hospital, USA. Of the 412 patients who underwent laparoscopic bariatric surgery between June 2009 and June 2011, we identified 25 patients who had Roux-en-Y gastric bypass (RYGB) originally, who underwent laparoscopic revisional surgery for weight regain. Preoperative and postoperative data were reviewed. Statistical analysis was performed using paired t test. This study includes 0 male and 25 female patients with an average age of 42 (range min to max: 28–58), mean original body mass index (BMI) of 54.6 kg/m2 (r = 37.3–80.7), average lowest BMI achieved of 32.2 (r = 20.1–50.9), and average BMI at the time of revision of 41.0 kg/m2 (r = 29.5–60.7, standard deviation (SD) = 8.5). All laparoscopic revisions consisted of resizing the gastric pouch by resection and recreating the gastrojejunostomy. Average hospital length of stay was 1.28 days (r = 1–4). Perioperative morbidity was 8 %; one patient developed a trocar site hernia which required repair, and another suffered postoperative bleeding requiring transfusion. There was no mortality. Postoperative BMI averages at 3, 6, 9, 12, and 24 months were 35.0 (SD = 7.15), 34.7 (SD = 4.26), 36.2 (SD = 7.63), 33.0 (SD = 6.58), and 44.2 (SD = 12.87), respectively. Statistically significant weight loss was achieved at 3 [t (10) = 6.74, p < 0.05], 6 [t (7) = 4.69, p < 0.05], 9 [t (9) = 2.94, p < 0.05], and 12 [t (6) = 3.78, p < 0.05] months. However, there was no statistically significant weight loss at 24 months postoperatively [t (4) = −0.16, p > 0.05]. Laparoscopic revisional bariatric surgery can be performed with significant weight loss up to 1 year postoperatively. However, additional studies are required to evaluate longer-term success.

Keywords

Bariatric surgery Bariatric revisional surgery Laparoscopic 

Abbreviations

BMI

Body mass index

EWL

Excess weight loss

Kg

Kilograms

GJ

Gastrojejunostomy

RYGB

Roux-en-Y gastric bypass

HTN

Hypertension

DM

Diabetes mellitus

GERD

Gastroesophageal reflux disease

Notes

Conflict of Interest

The authors have no conflicts of interests or sources of financial support to declare.

References

  1. 1.
    Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005;294:1909–17.PubMedCrossRefGoogle Scholar
  2. 2.
    Mechanick JI, Kushner RF, Sugerman HJ, American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery, et al. Medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Surg Obes Relat Dis. 2008;4:109–84.CrossRefGoogle Scholar
  3. 3.
    Elder KA, Wolfe BM. Bariatric surgery: a review of procedures and outcomes. Gastroenterology. 2007;132:2253–71.PubMedCrossRefGoogle Scholar
  4. 4.
    Thompson CC, Slattery J, Bundga ME, et al. Peroral endoscopic reduction of dilated gastrojejunal anastomosis after Roux-en-Y gastric bypass: a possible new option for patients with weight regain. Surg Endosc. 2006;20:1744–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Onguti SK, Ortega G, Onwugbufor M, et al. Effective weight loss management with endoscopic gastric plication using StomaphyX device: is it achievable? Surg Obes Relat Dis. 2013;9:113–7.CrossRefGoogle Scholar
  6. 6.
    Higa KD, Boone K, Nimeri A, et al. Gastric bypass: increased restriction for poor weight loss. Surg Endosc. 2007;21:1922–3.PubMedCrossRefGoogle Scholar
  7. 7.
    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.PubMedCrossRefGoogle Scholar
  8. 8.
    Brolin RE, Cody RP. Weight loss outcome of revisional bariatric operations varies according to the primary procedure. Ann Surg. 2008;248:227–32.PubMedCrossRefGoogle Scholar
  9. 9.
    Abu Dayyeh BK, Thompson CC. Obesity and bariatrics for the endoscopist: new techniques. Therap Adv Gastroenterol. 2011;4:433–42.PubMedCrossRefGoogle Scholar
  10. 10.
    Bolton J, Gill RS, Al-Jahdali A, et al. Endoscopic revision (StomaphyX) versus formal surgical revision (gastric bypass) for failed vertical band gastroplasty. J Obes. 2013:108507.Google Scholar
  11. 11.
    Vijgen GH, Schouten R, Bouvy ND, et al. Salvage banding for failed Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2012;8:803–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Rawlins ML, Teel 2nd D, Hedgcorth K, et al. Revision of Roux-en-Y gastric bypass to distal bypass for failed weight loss. Surg Obes Relat Dis. 2011;7:45–9.PubMedCrossRefGoogle Scholar
  13. 13.
    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
  14. 14.
    Consensus Development Conference Panel. NIH conference: gastrointestinal surgery for severe obesity. Ann Intern Med. 1991;115:956–61.CrossRefGoogle Scholar
  15. 15.
    Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Statement. Am J ClinNutr. 1992;55:615–19.Google Scholar
  16. 16.
    Encinosa WE, Bernard DM, Steiner CA, et al. Use and costs of bariatric surgery and prescription weight-loss medications. Health Aff. 2005;24:1039–46.CrossRefGoogle Scholar
  17. 17.
    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.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Macarthur RI, Smith DE, Hermereck AS, et al. Revision of gastric bypass. Am J Surg. 1980;140:751–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Schwartz RW, Strodel WE, Simpson WS, et al. Gastric bypass revision: lessons learned from 920 cases. Surgery. 1988;104:806–12.PubMedGoogle Scholar
  20. 20.
    Mason EE, Printen KJ, Hartford CE, et al. Optimizing results of gastric bypass. Ann Surg. 1975;182:405–13.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Muller MK, Wildi S, Scholz T, et al. Laparoscopic pouch resizing and redo of gastro-jejunal anatomosis for pouch dilation following gastric bypass. Obes Surg. 2005;15:1089–95.PubMedCrossRefGoogle Scholar
  22. 22.
    Owens ML, Sczepaniak JP. Size really does matter—role of gastrojejunostomy in postoperative weight loss. Surg Obes Relat Dis. 2009;5:357–61.PubMedCrossRefGoogle Scholar
  23. 23.
    Irani K, Youn HA, Ren-Fielding CJ, et al. Midterm results for gastric banding as salvage procedure for patients with weight loss failure after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2011;7:219–24.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Abdulrahman Hamdi
    • 1
  • Christopher Julien
    • 1
  • Phillip Brown
    • 1
  • Ian Woods
    • 1
  • Anas Hamdi
    • 1
  • Gezzer Ortega
    • 1
  • Terrence Fullum
    • 1
  • Daniel Tran
    • 1
  1. 1.Howard University HospitalWashingtonUSA

Personalised recommendations