Skip to main content

Laparoscopic reversal of Roux-en-Y gastric bypass into normal anatomy with or without sleeve gastrectomy

Abstract

Objective

This study was designed to describe and analyze the outcomes after laparoscopic reversal to normal anatomy (NA) with or without concomitant “sleeve gastrectomy” (SG), after Roux-en-Y gastric bypass (RYGB). Reversal has been proposed as corrective strategy after RYGB.

Methods

We propose a retrospective analysis of a prospectively kept database.

Results

From January 2005 to October 2012, 20 female patients underwent laparoscopic reversal after RYGB for one or more of the following conditions: hypoglycaemic syndrome (nine patients), weight regain (six patients), severe dumping (six patients), and cachexia (two patients). Preoperative BMI was 28.0 (19.2–40.3) kg/m². Reversal was performed to NA in ten patients and included a SG procedure in another ten. Postoperative complications included one bleeding and three leaks (15 %; all in SG patients). Mean hospital stay was 7 days. Mortality was 0. With a mean follow-up of 11.5 months, all but one patient recovered from their initial condition. However, three developed severe gastroesophageal reflux disease (GERD) symptoms and three had chronic diarrhoea.

Conclusions

Outcomes of laparoscopic reversal of RYGB are good, but complications may occur when SG is added. The surgical alterations caused by the reversal may explain the GERD or diarrhoea experienced by some patients.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Stroh C, Manger T (2011) Complications of gastric banding versus gastric bypass. Obes Facts 1:24–28

    Article  Google Scholar 

  2. Himpens J, Verbrugghe A, Cadière GB et al (2012) Long-term results of laparoscopic Roux-en-Y Gastric bypass: evaluation after 9 years. Obes Surg 22:1586–1593

    PubMed  Article  Google Scholar 

  3. Wittgrove AC, Clark GW, Tremblay LJ (1994) Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg 4:353–357

    PubMed  Article  Google Scholar 

  4. Dapri G, Cadière GB, Himpens J (2011) Laparoscopic conversion of Roux-en-Y gastric bypass to distal gastric bypass for weight regain. J Laparoendosc Adv Surg Tech A 21:19–23

    PubMed  Article  Google Scholar 

  5. Gumbs AA, Pomp A, Gagner M (2007) Revisional bariatric surgery for inadequate weight loss. Obes Surg 17:1137–1145

    PubMed  Article  Google Scholar 

  6. Sapala JA, Sapala MA, Resto Soto AD et al (1991) A technique for converting the Roux-en-Y gastric bypass to a modified biliopancreatic diversion. Obes Surg 1:311–313

    PubMed  Article  Google Scholar 

  7. Himpens J, Dapri G, Cadière GB (2006) Laparoscopic conversion of the gastric bypass into a normal anatomy. Obes Surg 16:908–912

    PubMed  Article  Google Scholar 

  8. Suter M, Ralea S, Millo P et al (2012) Laparoscopic Roux-en-Y Gastric bypass after failed vertical banded gastroplasty: a multicenter experience with 203 patients. Obes Surg 22:1554–1561

    PubMed  Article  CAS  Google Scholar 

  9. Worni M, Ostbye T, Shah A et al (2012) High risks for adverse outcomes after gastric bypass surgery following failed gastric banding: a population-based trend analysis of the United States. Ann Surg 257(2):279–286

    Article  Google Scholar 

  10. Gautier T, Sarcher T, Contival N et al (2013) Indications and mid-term results of conversion from sleeve gastrectomy to Roux-en-Y gastric bypass. Obes Surg 23:212–215

    PubMed  Article  Google Scholar 

  11. Mognol P, Chosidow D, Marmuse JP (2004) Laparoscopic conversion of laparoscopic gastric banding to Roux-en Y gastric bypass: a review of 70 patients. Obes Surg 14:1349–1353

    PubMed  Article  Google Scholar 

  12. Hii MW, Lake AC, Kenfield C et al (2012) Laparoscopic conversion of failed gastric banding to Roux-en-Y gastric bypass. Short-term follow-up and technical considerations. Obes Surg 22:1022–1028

    PubMed  Article  CAS  Google Scholar 

  13. Patel S, Szomstein S, Rosenthal RJ (2011) Reasons and outcomes of reoperative bariatric surgery for failed and complicated procedures (excluding adjustable gastric banding). Obes Surg 21:1209–1219

    PubMed  Article  Google Scholar 

  14. Simper SC, Erzinger JM, McKinlay R et al (2010) Laparoscopic reversal of gastric bypass with sleeve gastrectomy for treatment of recurrent retrograde intussusception and Roux stasis syndrome. Surg Obes Relat Dis 6:684–688

    PubMed  Article  Google Scholar 

  15. Varban O, Ardestani A, Azagury D et al (2012) Resection or reduction? The dilemma of managing retrograde intussusception after Roux-en-Y gastric bypass. Surg Obes Relat Dis. doi:10.1016/j.soard.2012.05.004

  16. Schouten R, van Dielen FM, van Gemert WG et al (2007) Conversion of vertical banded gastroplasty to Roux-en-Y gastric bypass results in restoration of the positive effect on weight loss and co-morbidities: evaluation of 101 patients. Obes Surg 17:622–630

    PubMed  Article  Google Scholar 

  17. Brolin RE, Asad M (2009) Rationale for reversal of failed bariatric operation. Surg Obes Relat Dis 5:673–677

    PubMed  Article  Google Scholar 

  18. Chousleb E, Patel S, Szomstein S et al (2012) Reasons and operative outcomes after reversal of gastric bypass and jejunoileal bypass. Obes Surg 22:1611–1616

    PubMed  Article  Google Scholar 

  19. Economou TP, Cullen JJ, Mason EE et al (1995) Reversal of small intestinal operations and concomitant vertical banded gastroplasty: long-term outcome. J Am Coll Surg 181:160–164

    PubMed  CAS  Google Scholar 

  20. Varela JE, Hinojosa MW, Nguyen NT (2008) Laparoscopy should be the approach of choice for acute appendicitis in the morbidly obese. Am J Surg 196:218–222

    PubMed  Article  Google Scholar 

  21. Carter JJ, Whelan RL (2001) The immunologic consequences of laparoscopy in oncology. Surg Oncol Clin N Am 10:655–677

    PubMed  CAS  Google Scholar 

  22. Nguyen NT, Ho HS, Palmer LS et al (2000) A comparison study of laparoscopic versus open gastric bypass for morbid obesity. J Am Coll Surg 191:149–155 discussion 155–157

    PubMed  Article  CAS  Google Scholar 

  23. Dapri G, Himpens J, Cadière GB (2010) Laparoscopic conversion of Roux-en-Y gastric bypass to biliopancreatic diversion. Surg Endosc 24:1490–1493

    PubMed  Article  CAS  Google Scholar 

  24. Rabiee A, Magruder JT, Salas-Carrillo R et al (2011) Hyperinsulemic hypoglycemia after Roux-en-Y gastric bypass: unraveling the role of gut hormonal and pancreatic endocrine dysfunction. J Surg Res 167:199–205

    PubMed  Article  CAS  Google Scholar 

  25. Service GJ, Thompson GB, Service FJ (2005) Hyperinsulinemic hypoglycaemia with nesidioblastosis after gastric-bypass surgery. N Engl J Med 353:249–254

    PubMed  Article  CAS  Google Scholar 

  26. Marsk R, Jonas E, Rasmussen F et al (2010) Nationwide cohort study of post-gastric bypass hypoglycaemia including 5,040 patients undergoing surgery for obesity in 1986–006 in Sweden. Diabetologica 53(2307–11):27

    Google Scholar 

  27. Clancy TE, Moore FD, Zinner MJ (2006) Post-gastric bypass hyperinsulinism with nesidioblastosis: subtotal or total pancreatectomy may be needed to prevent recurrent hypoglycemia. J Gastrointest Surg 10:1116–1119

    PubMed  Article  Google Scholar 

  28. Goldfine AB, Mun EC, Devine E et al (2007) Patients with neuroglycopenia after gastric bypass surgery have exaggerated incretin and insulin secretory responses to a mixed meal. J Clin Endocrinol Metab 92:4678–4685

    PubMed  Article  CAS  Google Scholar 

  29. McLaughlin T, Peck M, Holst J et al (2010) Reversible hyperinsulinemic hypoglycemia after gastric bypass: a consequence of altered nutrient delivery. J Clin Endocrinol Metab 95:1851–1855

    PubMed  Article  CAS  Google Scholar 

  30. Prager G (2012) 7th Frankfurter Meeting. Laparoscopic surgery for obesity and metabolic disorders. “Diabetes surgery BMI > 35: which procedure?”

  31. Signorovitch JE, Macaulay D, Diener M et al (2012) Hypoglycaemia and accident risk in people with type 2 diabetes mellitus treated with non-insulin antidiabetes drugs. Diabetes Obes Metab. doi:10.1111/dom.12031

    PubMed  Google Scholar 

  32. Kim SH, Abbasi F, Lamendola C et al (2010) Glucose-stimulated insulin secretion in gastric bypass patients with hypoglycemic syndrome: no evidence for inappropriate pancreatic beta-cell function. Obes Surg 20:1110–1116

    PubMed  Article  Google Scholar 

  33. Arao T, Okada Y, Hirose A et al (2006) A rare case of adult onset nesidioblastosis treated successfully with diazoxide. Endocr J 53:95–100

    PubMed  Article  Google Scholar 

  34. Moreira RO, Moreira RB, Machado NA et al (2008) Post-prandial hypoglycaemia after bariatric surgery: pharmacological treatment with verapamil and acarbose. Obes Surg 18:1618–1621

    PubMed  Article  Google Scholar 

  35. Z’graggen K, Guweidhi A, Steffen R et al (2008) Severe recurrent hypoglycemia after gastric bypass surgery. Obes Surg 18:981–988

    PubMed  Article  Google Scholar 

  36. Himpens J, Coromina L, Verbrugghe A et al (2012) Outcomes of revisional procedures for insufficient weight loss or weight regain after Roux-en-Y gastric bypass. Obes Surg 22:1746–1754

    PubMed  Article  Google Scholar 

  37. Alvarez GC, Faria EN, Beck M et al (2007) Laparoscopic spleen preserving distal pancreatectomy as treatment for nesidioblastosis after gastric bypass surgery. Obes Surg 17:550–552

    PubMed  Article  Google Scholar 

  38. Lee CJ, Brown T, Magnuson TH et al (2013) Hormonal response to a mixed-meal challenge after reversal of gastric bypass for hypoglycemia. J Clin Endocrinol Metab (in press)

  39. Poitou Bernert C, Ciangura C, Coupaye M et al (2007) Nutritional deficiency after gastric bypass: diagnosis, prevention and treatment. Diabetes Metab 33:13–24

    PubMed  Article  CAS  Google Scholar 

  40. Mor A, Keenan E, Portenier D et al (2012) Case-matched analysis comparing outcomes of revisional versus primary laparoscopic Roux-en-Y gastric bypass. Surg Endosc 27(2):548–552

    PubMed  Article  Google Scholar 

  41. Burge H, Clark PA (1959) Post-vagotomy diarrhoea: its cause and prevention. Br Med J 1:1142–1144

    PubMed  Article  CAS  Google Scholar 

  42. Sawyers JL (1990) Management of postgastrectomy syndromes. Am J Surg 159:8–14

    PubMed  Article  CAS  Google Scholar 

  43. Camilleri M, Prather CM (1998) Gastric motor physiology and motor disorders. In: Feldman M, Scharschmidt BF, Sleisenger MH (eds) Sleisenger & Fordtran’s GI and liver disease, vol 6th edn. Philadelphia, Saunders, pp 572–586

    Google Scholar 

  44. Geer RJ, Richards WO, O’Dorisio TM et al (1990) Efficacy of octreotide in the treatment of severe postgastrectomy dumping syndrome. Ann Surg 212:678–687

    PubMed  Article  CAS  Google Scholar 

  45. Laferrère B (2011) Do we really know why diabetes remits after gastric bypass surgery? Endocrine 40:162–167

    PubMed  Article  Google Scholar 

  46. Leitman IM, Virk CS, Avgerinos DV et al (2010) Early results of trans-oral endoscopic plication and revision of the gastric pouch and stoma following Roux-en-Y gastric bypass surgery. JSLS 14:217–220

    PubMed  Article  Google Scholar 

  47. Gagner M, Gentileschi P, de Csepel J et al (2002) Laparoscopic reoperative bariatric surgery: experience from 27 consecutive patients. Obes Surg 12:254–260

    PubMed  Article  Google Scholar 

  48. Nesset EM, Kendrick ML, Houghton SG et al (2007) A two-decade spectrum of revisional bariatric surgery at a tertiary referral center. Surg Obes Relat Dis 3:25–30

    PubMed  Article  Google Scholar 

  49. Khaitan L, van Sickle K, Lin E et al (2005) Laparoscopic revision of bariatric procedures: is it feasible? Am Surg 71:6–12

    PubMed  Google Scholar 

  50. Gagne D, McCormick J, Papasavas P et al (2003) Laparoscopic revision of failed open bariatric procedures. Surg Endosc 17:413–415

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

The authors thank Dr. Katherine Persyn for her artist work to illustrate the article.

Disclosure

Dr. Ramon Vilallonga and Dr. van de Vrande have no conflicts of interest. Dr. Jacques Himpens is a consultant for Ethicon Endosurgery and organizes workshops for Gore.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ramon Vilallonga.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Vilallonga, R., van de Vrande, S. & Himpens, J. Laparoscopic reversal of Roux-en-Y gastric bypass into normal anatomy with or without sleeve gastrectomy. Surg Endosc 27, 4640–4648 (2013). https://doi.org/10.1007/s00464-013-3087-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-013-3087-0

Keywords

  • Reversal
  • Roux-en-Y gastric bypass
  • Normal anatomy
  • Sleeve gastrectomy
  • Hypoglycemia
  • Laparoscopy