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

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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.

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Authors and Affiliations

  1. Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Hepato-Pancreato-Biliary Surgery, Liver Transplantation, Pitié-Salpêtrière University Hospital, Pierre & Marie Curie University, 47-83 Boulevard de l’Hôpital, 75013, Paris, France

    Laurent Genser & Jean-Michel Siksik

  2. Department of digestive surgery, Générale de Santé (GDS), Clinique Geoffroy-Saint Hilaire, 75005, Paris, France

    Antoine Soprani & Jean Cady

  3. Division of Bariatric Surgery, Department of Surgery, Hôpital du Sacré-Coeur, University of Montreal, Montreal, QC, H4J1C5, Canada

    Malek Tabbara

  4. Centre Chirurgical de l’Obésité, Clinique Saint Michel, Toulon, France

    Sergio Carandina

Authors
  1. Laurent Genser
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  2. Antoine Soprani
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  3. Malek Tabbara
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  4. Jean-Michel Siksik
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  5. Jean Cady
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  6. Sergio Carandina
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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

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Correspondence to Laurent Genser.

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Genser, L., Soprani, A., Tabbara, M. et al. Laparoscopic reversal of mini-gastric bypass to original anatomy for severe postoperative malnutrition. Langenbecks Arch Surg 402, 1263–1270 (2017). https://doi.org/10.1007/s00423-017-1615-4

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  • DOI: https://doi.org/10.1007/s00423-017-1615-4

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