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Management of Excessive Weight Loss Following Laparoscopic Roux-en-Y Gastric Bypass: Clinical Algorithm and Surgical Techniques

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Abstract

Background

There are no clinical guidelines or published studies addressing excessive weight loss and protein calorie malnutrition following a standard Roux-en-Y gastric bypass (RYGB) to guide nutritional management and treatment strategies. This study demonstrates the presentation, clinical algorithm, surgical technique, and outcomes of patients afflicted and successfully treated with excessive weight loss following a standard RYGB.

Methods

Three patients were successfully reversed to normal anatomy after evaluation, management, and treatment by multidisciplinary team. Lowest BMI (kg/m2) was 18.9, 17.9, and 14.2, respectively.

Results

Twelve-month post-operative BMI (kg/m2) was 28.9, 22.8, and 26.1, respectively. Lowest weight (lbs) was 117, 128, and 79, respectively. Twelve-month post-operative weight (lbs) was 179, 161, and 145, respectively. Pre-reversal gastrostomy tube was inserted into the remnant stomach to demonstrate weight gain and improve nutritional status prior to reversal to original anatomy.

Conclusion

We propose a practical clinical algorithm for the work-up and management of patients with excessive weight loss and protein calorie malnutrition after standard RYGB including reversal to normal anatomy.

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Conflict of Interest

The authors declare that they have no competing interests.

Consent

For this type of study, formal consent is not required. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Authors and Affiliations

  1. Department of General Surgery, Division of Bariatric Surgery, St. Luke’s University Health Network, Allentown, PA, USA

    Ikemefuna Akusoba, T. Javier Birriel & Maher El Chaar

Authors
  1. Ikemefuna Akusoba
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  2. T. Javier Birriel
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  3. Maher El Chaar
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Correspondence to Maher El Chaar.

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Akusoba, I., Birriel, T.J. & El Chaar, M. Management of Excessive Weight Loss Following Laparoscopic Roux-en-Y Gastric Bypass: Clinical Algorithm and Surgical Techniques. OBES SURG 26, 5–11 (2016). https://doi.org/10.1007/s11695-015-1775-7

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  • DOI: https://doi.org/10.1007/s11695-015-1775-7

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