Skip to main content
SpringerLink
Log in

Laparoscopic Wedge Resection of Gastrojejunostomy for Weight Recidivism after Gastric Bypass

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Weight recidivism after Roux-en-Y gastric bypass (RYGB) is a common problem. Often, this weight loss failure or regain may be due to a wide gastrojejunostomy (GJ). We evaluated the feasibility and safety of a novel approach of laparoscopic wedge resection of gastrojejunostomy (LWGJ) for a wide stoma after RYGB associated with weight recidivism.

Methods

This is a single-center retrospective study of a prospectively collected database. We analyzed outcomes of patients with weight recidivism after RYGB and a documented wide GJ (>2 cm) on imaging, who underwent LWGJ between 11/2013 and 05/2016.

Results

Nine patients underwent LWGJ for dilated stomas. All patients were female with a mean ± SD age of 53 ± 7 years. Mean interval between RYGB and LWGJ was 9 ± 3 years. All cases were performed laparoscopically with no conversions. Mean operative time and hospital stay were 86 ± 9 min and 1.2 ± 0.4 days, respectively. The median(IQR) follow-up time was 14(12–18) months. During follow-up, there were no deaths, postoperative complications, or unplanned readmissions or reoperations. The mean and median(IQR) BMI before RYGB and LWGJ were 55.4 ± 8.1 kg/m2 and 56.1(47.9–61.7) and 43.4 ± 8.6 kg/m2 and 42.1(38.3–47.1), respectively. One year after LWGJ, mean and median(IQR) BMI significantly decreased to 34.9 ± 7.3 kg/m2 and 33.3(31.7–35.0) corresponding to a mean %EWL of 64.6 ± 19.9 (P < 0.05).

Conclusions

LWGJ is safe and can lead to further weight loss in patients experiencing weight recidivism after RYGB with a wide GJ (>2 cm). Long-term follow-up is needed to determine the efficacy and durability of LWGJ and compare its outcomes with other endoscopic/surgical approaches for weight recidivism after RYGB with a documented wide GJ.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. American Society for Metabolic and Bariatric Surgery. Estimate of Bariatric Surgery Numbers, 2011–2015. 2016 [cited 2016 August 5th]; http://asmbs.org/resources/estimate-of-bariatric-surgery-numbers].

  2. 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(5):734–40.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Magro DO et al. Long-term weight regain after gastric bypass: a 5-year prospective study. Obes Surg. 2008;18(6):648–51.

    Article  PubMed  Google Scholar 

  4. Tran DD et al. Revision of roux-En-Y gastric bypass for weight regain: a systematic review of techniques and outcomes. Obes Surg. 2016;26(7):1627–34.

    Article  PubMed  Google Scholar 

  5. Gumbs AA, Pomp A, Gagner M. Revisional bariatric surgery for inadequate weight loss. Obes Surg. 2007;17(9):1137–45.

    Article  PubMed  Google Scholar 

  6. Elnahas AI, Jackson TD, Hong D. Management of Failed Laparoscopic Roux-en-Y gastric bypass. Bariatr Surg Pract Patient Care. 2014;9(1):36–40.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Wang B et al. Utility of barium studies for patients with recurrent weight gain after Roux-en-Y gastric bypass. Clin Radiol. 2015;70(1):67–73.

    Article  CAS  PubMed  Google Scholar 

  8. Yimcharoen P et al. Endoscopic findings and outcomes of revisional procedures for patients with weight recidivism after gastric bypass. Surg Endosc. 2011;25(10):3345–52.

    Article  PubMed  Google Scholar 

  9. Scheirey CD et al. Radiology of the laparoscopic Roux-en-Y gastric bypass procedure: conceptualization and precise interpretation of results. Radiographics. 2006;26(5):1355–71.

    Article  PubMed  Google Scholar 

  10. Catalano MF et al. Weight gain after bariatric surgery as a result of a large gastric stoma: endotherapy with sodium morrhuate may prevent the need for surgical revision. Gastrointest Endosc. 2007;66(2):240–5.

    Article  PubMed  Google Scholar 

  11. Morton JM. Weight gain after bariatric surgery as a result of large gastric stoma: endotherapy with sodium morrhuate to induce stomal stenosis may prevent the need for surgical revision. Gastrointest Endosc. 2007;66(2):246–7.

    Article  PubMed  Google Scholar 

  12. Switzer NJ et al. Revisional bariatric surgery. Surg Clin North Am. 2016;96(4):827–42.

    Article  PubMed  Google Scholar 

  13. Dakin GF et al. Endoluminal revision of gastric bypass for weight regain—a systematic review. Surg Obes Relat Dis. 2013;9(3):335–42.

    Article  PubMed  Google Scholar 

  14. Mali Jr J et al. Influence of the actual diameter of the gastric pouch outlet in weight loss after silicon ring Roux-en-Y gastric bypass: an endoscopic study. Obes Surg. 2010;20(9):1231–5.

    Article  PubMed  Google Scholar 

  15. Loewen M, Barba C. Endoscopic sclerotherapy for dilated gastrojejunostomy of failed gastric bypass. Surg Obes Relat Dis. 2008;4(4):539–42. discussion 542-3

    Article  PubMed  Google Scholar 

  16. American Society for Metabolic and Bariatric Surgery. Bariatric surgery misconceptions; Available at: http://asmbs.org/patients/bariatric-surgery-misconceptions. Accessed January 17, 2017.

  17. Karmali S et al. Weight recidivism post-bariatric surgery: a systematic review. Obes Surg. 2013;23(11):1922–33.

    Article  PubMed  Google Scholar 

  18. Ma P, Reddy S, Higa KD. Revisional bariatric/metabolic surgery: what dictates its indications? Curr Atheroscler Rep. 2016;18(7):42.

    Article  PubMed  Google Scholar 

  19. Faria SL et al. Nutritional management of weight regain after bariatric surgery. Obes Surg. 2010;20(2):135–9.

    Article  PubMed  Google Scholar 

  20. Spinosa SR, Valezi AC. Endoscopic findings of asymptomatic patients one year after Roux-en-Y gastric bypass for treatment of obesity. Obes Surg. 2013;23(9):1431–5.

    Article  PubMed  Google Scholar 

  21. Abu Dayyeh BK, Lautz DB, Thompson CC. Gastrojejunal stoma diameter predicts weight regain after Roux-en-Y gastric bypass. Clin Gastroenterol Hepatol. 2011;9(3):228–33.

    Article  PubMed  Google Scholar 

  22. Jirapinyo P et al. Evaluation of an endoscopic suturing device for transoral outlet reduction in patients with weight regain following Roux-en-Y gastric bypass. Endoscopy. 2013;45(7):532–6.

    Article  CAS  PubMed  Google Scholar 

  23. 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(5):650–4.

    Article  PubMed  Google Scholar 

  24. Chaux F, Bolanos E, Varela JE. Lengthening of the biliopancreatic limb is a key step during revisional Roux-en-Y gastric bypass for weight regain and diabetes recurrence. Surg Obes Relat Dis. 2015;11(6):1411.

    Article  PubMed  Google Scholar 

  25. Orci L, Chilcott M, Huber O. Short versus long Roux-limb length in roux-en-Y gastric bypass surgery for the treatment of morbid and super obesity: a systematic review of the literature. Obes Surg. 2011;21(6):797–804.

    Article  PubMed  Google Scholar 

  26. Aminian A et al. Critical appraisal of salvage banding for weight loss failure after gastric bypass. Surg Obes Relat Dis. 2015;11(3):607–11.

    Article  PubMed  Google Scholar 

  27. Vijgen GH et al. Salvage banding for failed Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2012;8(6):803–8.

    Article  PubMed  Google Scholar 

  28. Moon RC, Teixeira AF, Jawad MA. Treatment of weight regain following Roux-en-Y gastric bypass: revision of pouch, creation of new gastrojejunostomy and placement of proximal pericardial patch ring. Obes Surg. 2014;24(6):829–34.

    Article  PubMed  Google Scholar 

  29. Trelles N, Gagner M. Revision bariatric surgery: laparoscopic conversion of failed gastric bypass to biliopancreatic diversion with duodenal switch. Minerva Chir. 2009;64(3):277–84.

    CAS  PubMed  Google Scholar 

  30. 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(6):611–8.

    Article  PubMed  Google Scholar 

  31. Ryou M, Ryan MB, Thompson CC. Current status of endoluminal bariatric procedures for primary and revision indications. Gastrointest Endosc Clin N Am. 2011;21(2):315–33.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Gallo AS et al. Endoscopic revision of gastric bypass: holy grail or epic fail? Surg Endosc. 2016;30(9):3922–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Division of General Surgery, Center for Bariatric Surgery, McGill University Health Center Montreal General Hospital, 1650 Cedar Avenue, Room: E16-152, Montreal, QC, H3G 1A4, Canada

    Aly Elbahrawy, Alexandre Bougie, Mohammad Albader, Rajesh Aggarwal, Sebastian Demyttenaere, Amin Andalib & Olivier Court

  2. Department of Clinical and Experimental Surgery, Medical Research Institute, Alexandria University, Alexandria, Egypt

    Aly Elbahrawy

Authors
  1. Aly Elbahrawy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexandre Bougie
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohammad Albader
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rajesh Aggarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sebastian Demyttenaere
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Amin Andalib
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Olivier Court
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aly Elbahrawy.

Ethics declarations

Conflict of Interest

AE, AB, MA, RA, SD, AA, and OC do not have any conflicts of interest or financial ties to disclose. RA reports personal fees from Applied Medical, outside the submitted work. OC reports grants from Ethicon/Johnson & Johnson, outside the submitted work.

Human and Animal Rights

Given the retrospective nature of our study, a formal consent was not required.

Informed Consent

Informed consent was obtained from all patients prior to revisional surgery but informed consent for participating in the study does not apply.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Elbahrawy, A., Bougie, A., Albader, M. et al. Laparoscopic Wedge Resection of Gastrojejunostomy for Weight Recidivism after Gastric Bypass. OBES SURG 27, 2829–2835 (2017). https://doi.org/10.1007/s11695-017-2706-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-017-2706-6

Keywords

Search

Navigation