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

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery European School of Laparoscopic Surgery Saint-Pierre University Hospital, 322, Rue Haute, 1000, Brussels, Belgium

    Giovanni Dapri, Guy Bernard Cadière & Jacques Himpens

Authors
  1. Giovanni Dapri
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  2. Guy Bernard Cadière
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  3. Jacques Himpens
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Corresponding author

Correspondence to Giovanni Dapri.

Additional information

This paper is presented at the XV World Congress of International Federation for the Surgery of Obesity and Metabolic Disorders, Long Beach CA, USA, September 3–7, 2010

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Dapri, G., Cadière, G.B. & Himpens, J. Laparoscopic Reconversion of Roux-en-Y Gastric Bypass to Original Anatomy: Technique and Preliminary Outcomes. OBES SURG 21, 1289–1295 (2011). https://doi.org/10.1007/s11695-010-0252-6

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