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Roux-en-Y Gastric Bypass Reversal for Severe Malnutrition and Cirrhosis

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Abstract

Background

Severe post-operative malnutrition (SM) is a dreaded complication after gastric bypass often related to the short bowel syndrome consecutive limb length mismeasurement or intestinal resections. Patients with rapid weight loss or malnutrition can experience liver failure with cirrhosis and require liver transplantation (LT). Malnutrition can constitute a contraindication to LT since it negatively impacts on postoperative morbidity. RYGB reversal is an effective option to consider when nutritional support has failed. We describe the performance of a RYGB reversal in a pre-LT setting.

Material and Methods

A 36-year-old patient with morbid obesity (weight, 140 kg; BMI, 50.1 kg/m2) underwent a RYGB 9 years ago. She presented with 85 kg weight loss (i.e., 60.7% total body weight loss) associated with SM and hepatocellular insufficiency. LT was considered but contraindicated because of SM. An intensive nutritional support was attempted but failed and the RYGB reversal was recommended.

Results

Laparoscopic exploration revealed ascites, cirrhosis, and splenomegaly. The whole small bowel measurement revealed a short gut. Alimentary, biliary, and common channel limb lengths were 250 cm, 150 cm, and 30 cm long. The alimentary limb was stapled off the gastric pouch and the gastrojejunostomy was resected. After resection of the gastrojejunostomy, linear stappled gastro-gastrostomy and jéjuno-jejunostomy were performed to restore the normal anatomy. At 1 year, malnutrition was resolved and the cirrhosis was stabilized.

Conclusion

Reversal to normal anatomy appeared effective and safe in this setting but must be considered only after failure of intensive medical management. Careful bowel measurement is mandatory to prevent patients from this complication.

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References

  1. Schauer DP, Feigelson HS, Koebnick C, et al. Bariatric surgery and the risk of cancer in a large multisite cohort. Ann Surg. 2017.

  2. Bétry C, Disse E, Chambrier C, et al. Need for intensive nutrition care after bariatric surgery: is mini gastric bypass at fault? JPEN J Parenter Enteral Nutr. 2016.

  3. Genser L, Soprani A, Tabbara M, et al. Laparoscopic reversal of mini-gastric bypass to original anatomy for severe postoperative malnutrition. Langenbeck’s Arch Surg. 2017;402:1263–70.

    Article  Google Scholar 

  4. Pernar LIM, Kim JJ, Shikora SA. Gastric bypass reversal - a 7-year experience. Surg Obes Relat Dis. 2016 [cited 2016 Apr 28];0. Available from: http://www.soard.org/article/S1550728916300302/abstract

  5. Caiazzo R, Lassailly G, Leteurtre E, et al. Rouxen-Y gastric bypass versus adjustable gastric banding to reduce nonalcoholic fatty liver disease: a 5-year controlled longitudinal study. Ann Surg. 2014;260:893–9.

    Article  PubMed  Google Scholar 

  6. Mahawar KK. Liver dysfunction with both Roux-en-Y and one-anastomosis gastric bypass is almost exclusively seen with longer than standard limb lengths. Obes Surg. 2018;28:548–9.

    Article  PubMed  Google Scholar 

  7. Eilenberg M, Langer FB, Beer A, et al. Significant liver-related morbidity after bariatric surgery and its reversal-a case series. Obes Surg. 2018;28:812–9.

    Article  PubMed  Google Scholar 

  8. Tsai J-H, Ferrell LD, Tan V, et al. Aggressive non-alcoholic steatohepatitis following rapid weight loss and/or malnutrition. Mod Pathol. 2017;30:834–42.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lazzati A, Iannelli A, Schneck A-S, et al. Bariatric surgery and liver transplantation: a systematic review a new frontier for bariatric surgery. Obes Surg. 2015;25:134–42.

    Article  PubMed  Google Scholar 

  10. Golse N, Bucur PO, Ciacio O, et al. A new definition of sarcopenia in patients with cirrhosis undergoing liver transplantation. Liver Transpl. 2017;23:143–54.

    Article  PubMed  Google Scholar 

  11. Mazurak VC, Tandon P, Montano-Loza AJ. Nutrition and the transplant candidate. Liver Transpl. 2017;23:1451–64.

    Article  PubMed  Google Scholar 

  12. Zaveri H, Dallal RM, Cottam D, et al. Indications and operative outcomes of gastric bypass reversal. Obes Surg. 2016;26:2285–90.

    Article  PubMed  Google Scholar 

  13. Moon RC, Frommelt A, Teixeira AF, et al. Indications and outcomes of reversal of Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2014.

  14. Chousleb E, Patel S, Szomstein S, et al. Reasons and operative outcomes after reversal of gastric bypass and jejunoileal bypass. Obes Surg. 2012;22:1611–6.

    Article  PubMed  Google Scholar 

  15. Dapri G, Cadière GB, Himpens J. Laparoscopic reconversion of Roux-en-Y gastric bypass to original anatomy: technique and preliminary outcomes. Obes Surg. 2011;21:1289–95.

    Article  PubMed  Google Scholar 

  16. 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. 2013;27:4640–8.

    Article  PubMed  Google Scholar 

  17. Campos GM, Ziemelis M, Paparodis R, et al. Laparoscopic reversal of Roux-en-Y gastric bypass: technique and utility for treatment of endocrine complications. Surg Obes Relat Dis. 2014;10:36–43.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Digestive Surgery, Générale de Santé (GDS), Clinique Geoffroy-Saint Hilaire, 75005, Paris, France

    N. Beghdadi & A. Soprani

  2. Department of Digestive Surgery, Hepatobiliary Surgery and Liver Transplantation, University Hospital of Tours, Tours, Centre-Val de Loire, France

    A. Kraemer & P. Bucur

  3. Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Metabolic Surgery, Avicenne University Hospital, Centre intégré Nord Francilien de la prise en charge de l’Obésité (CINFO), Université Paris XIII-UFR SMBH « Léonard de Vinci », 125 route de Stalingrad, 93000, Bobigny, France

    C. Barrat & L. Genser

Authors
  1. N. Beghdadi
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  2. A. Soprani
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  3. A. Kraemer
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  4. P. Bucur
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  5. C. Barrat
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  6. L. Genser
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Corresponding author

Correspondence to L. Genser.

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Beghdadi, N., Soprani, A., Kraemer, A. et al. Roux-en-Y Gastric Bypass Reversal for Severe Malnutrition and Cirrhosis. OBES SURG 29, 1442–1444 (2019). https://doi.org/10.1007/s11695-019-03770-2

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  • DOI: https://doi.org/10.1007/s11695-019-03770-2

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