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Remnant Gastrectomy and Gastric Bypass: A Systematic Review of Indications and Outcomes of Resectional Gastric Bypass

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In this systematic review, we aim to evaluate the reasons and outcomes behind remnant gastrectomy with or after gastric bypass procedures.


A total of 66 studies examining 1918 patients were included in this study with 70% of female predominance. Twenty studies reported RGB on 1751 patients and 46 studies reported remnant gastrectomy after gastric bypass in 167 patients. The most common etiology of RGB was related to the in situ remnant stomach neoplasia in 10 studies on 981 patients; mostly for preventive intentions in high prevalence areas. Remnant gastrectomy after gastric bypass was performed to treat a complication such as GGF, retrograde bile reflux gastritis, cancer mostly adenocarcinoma. Studies revealed that RGB has similar weight loss in comparison to standard Roux-en-Y gastric bypass.

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  1. Mahmoudieh M, Keleidari B, Hadipour P, et al. Comparative effectiveness of Roux-en-Y gastric bypass vs. one anastomosis gastric bypass on kidney function. Obes Surg. 2021;31:2464–70.

  2. Mahmoudieh M, Keleidari B, Salimi M, et al. The two different biliopancreatic limb lengths for Roux-en-Y gastric bypass. Obes Med. 2019;16:100146.

    Article  Google Scholar 

  3. Mahmoudieh M, Keleidari B, Afshin N, et al. The early results of the laparoscopic mini-gastric bypass/one anastomosis gastric bypass on patients with different body mass index. J Obes. 2020;1.

  4. Keleidari B, Mahmoudieh M, Kafi S, et al. Which one is better for non-alcoholic fatty liver disease, the Roux-en-Y gastric bypass or one anastomosis gastric bypass? A paired liver biopsy report. Obes Med. 2020;18:100205.

    Article  Google Scholar 

  5. Martin MJ, Mullenix PS, Steele SR, et al. A case-match analysis of failed prior bariatric procedures converted to resectional gastric bypass. Am J Surg. 2004;666–71.

  6. Csendes A, Burdiles P, Papapietro K, et al. Results of gastric bypass plus resection of the distal excluded gastric segment in patients with morbid obesity. J Gastrointest Surg. 2005;9:121–31.

    Article  PubMed  Google Scholar 

  7. Curry TK, Carter PL, Porter CA, et al. Resectional gastric bypass is a new alternative in morbid obesity. Am J Surg. 1998;175(5):367–70.

    Article  CAS  PubMed  Google Scholar 

  8. Mala T. The gastric remnant in Roux-en-Y gastric bypass challenges and possibilities. J Clin Gastroenterol. 2016 Aug 1;50(7)527–31.

  9. Cho YS, Park JH, Kim JS, et al. Clinical outcomes of resectional Roux-en-Y gastric bypass, compared to sleeve gastrectomy for severe obesity. Obes Surg. 2023;33:1338–46.

    Article  PubMed  Google Scholar 

  10. Cho M, Kaidar-Person O, Szomstein S, et al. Laparoscopic remnant gastrectomy: a novel approach to gastrogastric fistula after Roux-en-Y gastric bypass for morbid obesity. J Am Coll Surg. 2007;204:617–24.

    Article  PubMed  Google Scholar 

  11. Braghetto I, Martinez G, Korn O, et al. Laparoscopic subtotal gastrectomy in morbid obese patients: a valid option to laparoscopic gastric bypass in particular circumstances (prospective study). Surg Today. 2018;48:558–65.

    Article  PubMed  Google Scholar 

  12. Braghetto I, Korn O, Csendes A, et al. Laparoscopic treatment of obese patients with gastroesophageal reflux disease and Barrett’s esophagus: a prospective study. Obes Surg. 2012;22:764–72.

    Article  PubMed  Google Scholar 

  13. Csendes A, Burgos AM, Braghetto I. Classification and management of leaks after gastric bypass for patients with morbid obesity: a prospective study of 60 patients. Obes Surg. 2012;22:855–62.

    Article  PubMed  Google Scholar 

  14. See C, Carter PL, Elliott D, Mullenix P, Eggebroten W, Porter C, Watts D. An institutional experience with laparoscopic gastric bypass complications seen in the first year compared with open gastric bypass complications during the same period. Am J Surg. 2002 May 1;183(5):533–8.

  15. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg. 2021;88:105906.

    Article  PubMed  Google Scholar 

  16. Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007;7–1.

  17. Voellinger DC, Inabnet WB. Laparoscopic Roux-en-Y gastric bypass with remnant gastrectomy for focal intestinal metaplasia of the gastric antrum. Obes Surg. 2002;12:695–8.

  18. Tartamella F, Petracca G, Romboli A, et al. Laparoscopic gastric bypass with remnant gastrectomy in a super-super obese patient with gastric metaplasia: a surgical hazard? Acta Biomed. 2017;88:496–500.

    Google Scholar 

  19. Leuratti L, Alfa-Wali M, Bonanomi G. Intraoperative findings during a gastric bypass necessitating the removal of the gastric remnant. to proceed or not with the elective plan? Surg Obes Relat Dis. 2013;9:e69–71.

  20. Ghanem M, Teixeira AF, Jawad MA. Resection of the excluded stomach due to severe bleeding immediately after Roux-en-Y gastric bypass in a patient with Lynch syndrome: a case report. Surg Obes Relat Dis. 2017;13:e21–3.

    Article  PubMed  Google Scholar 

  21. Csendes A, Burgos AM, Smok G, et al. Effect of gastric bypass on Barrett’s esophagus and intestinal metaplasia of the cardia in patients with morbid obesity. J Gastrointest Surg. 2006;10:259–64.

    Article  PubMed  Google Scholar 

  22. Park JY, Kim YJ. Laparoscopic resectional gastric bypass: initial experience in morbidly obese Korean patients. Surg Today. 2015;45:1032–9.

    Article  PubMed  Google Scholar 

  23. Jain N et al. Duodenal neuroendocrine tumours in morbidly obese: Amalgamated strategy to optimise outcome. Journal of Minimal Access Surgery. 2021:17(2):249–2.

  24. Sohn VY, Arthurs ZM, Martin MJ, et al. Incidental pathologic findings in open resectional gastric bypass specimens with routine cholecystectomy and appendectomy. Surg Obes Relat Dis. 2008;4:608–11.

    Article  PubMed  Google Scholar 

  25. Quesada BM, Roff HE, Chiappetta Porras LT. Intraoperative finding of a gastric lymphoma during gastric bypass surgery. Obes Surg. 2007;17:847–8.

    Article  PubMed  Google Scholar 

  26. Braghetto I, Csendes A, Korn O, et al. Laparoscopic resectional gastric bypass in patients with morbid obesity: experience on 112 consecutive patients. J Gastrointest Surg. 2011;15:71–80.

    Article  PubMed  Google Scholar 

  27. Armstrong PJ, Chung MH, Holeman VR. The Gary P. Wratten surgical symposium resectional gastric bypass in the bariatric surgery practice of a small community hospital. Curr Surg. 1999 Sep 1;56(7–8):435–7.

  28. Brounts LR, Lesperance K, Lehmann R, et al. Resectional gastric bypass outcomes in active duty soldiers: a retrospective review. Surg Obes Relat Dis. 2009;5:657–61.

    Article  PubMed  Google Scholar 

  29. Noun R, Slim R, Chakhtoura G, et al. Resectional one anastomosis gastric bypass/mini gastric bypass as a novel option for revision of restrictive procedures: Preliminary results. J Obes. 2018;2018.

  30. Puri V, Alagappan A, Rubin M, et al. Management of bleeding from gastric remnant after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2012;8.

  31. Papasavas PK, Yeaney WW, Caushaj PF, Keenan RJ, Landreneau RJ, Gagné DJ. Perforation in the bypassed stomach following laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003 Oct 1;13(5):797–9.

  32. Mozzi E, Lattuada E, Zappa MA, et al. Failure of gastric bypass following several gastrointestinal hemorrhages. Obes Surg. 2010;20:523–5.

    Article  PubMed  Google Scholar 

  33. Rycx A, Maes H, Van Nieuwenhove Y. A rare complication of laparoscopic Roux-en-Y gastric bypass: case report of gastric remnant necrosis. Acta Chir Belg. 2023;123:62–4.

    Article  PubMed  Google Scholar 

  34. Pang AJ, Hagen J. Laparoscopic approach to a bleeding marginal ulcer fistulized to the gastric remnant in a patient post Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2017;13:1451–2.

    Article  PubMed  Google Scholar 

  35. Iranmanesh P, Manisundaran NV, Bajwa KS, et al. Management of acute gastric remnant complications after Roux-en-Y gastric bypass: a single-center case series. Obes Surg. 2020;30:2637–41.

    Article  PubMed  Google Scholar 

  36. Chahine E, Kassir R, Dirani M, et al. Surgical management of gastrogastric fistula after Roux-en-Y gastric bypass: 10-year experience. Obes Surg. 2018;28:939–44.

    Article  PubMed  Google Scholar 

  37. Suri K, Tran K, Whang G. Gastric remnant perforation in a gastric bypass patient secondary to splenic artery pseudoaneurysm: radiologic-surgical correlation. Clin Imaging. 2019;54:159–62.

    Article  PubMed  Google Scholar 

  38. Gys B, Mertens J, Ruppert M, et al. Cronkhite-Canada syndrome causing pouch outlet obstruction 5 years after roux-en-y gastric bypass. Acta Chir Belg. 2019;119:56–8.

    Article  PubMed  Google Scholar 

  39. Ivanecz A. Life threatening bleeding from duodenal ulcer after Roux-en-Y gastric bypass: case report and review of the literature. World J Gastrointest Endosc. 2014;6:625.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Arshava EV, Mitchell C, Thomsen T, et al. Delayed perforation of the defunctionalized stomach after Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis. 2006;2:472–6.

    Article  PubMed  Google Scholar 

  41. Spires WV., Morris DM. Bleeding duodenal ulcer after gastric bypass procedure for obesity. South Med J. 1987;80:1325–6.

  42. Abellán I, Ruíz De Angulo D, Parrilla P. Incidental gastric gastrointestinal stromal tumor (GIST) in the excluded stomach after Roux-en-Y gastric bypass: a case report and review of the literature. Surg Obes Relat Dis. 2014;10.

  43. De Roover A, Detry O, De Leval L, et al. Report of two cases of gastric cancer after bariatric surgery: lymphoma of the bypassed stomach after Roux-en-Y gastric bypass and gastrointestinal stromal tumor (GIST) after vertical banded gastroplasty. Obes Surg. 2006;16:928–31.

    Article  PubMed  Google Scholar 

  44. Escalona A, Guzmán S, Ibáñez L, et al. Gastric cancer after Roux-en-Y gastric bypass. Obes Surg. 2005;15:423–7.

    Article  PubMed  Google Scholar 

  45. Khitin L, Roses RE, Birkett DH. Cancer in the gastric remnant after gastric bypass: a case report. Curr Surg. 2003;60:521–3.

    Article  PubMed  Google Scholar 

  46. Lord RV, Edwards PD, Coleman MJ. Case report gastric cancer in the bypassed segment after operation for morbid obesity. Aust N Z J Surg. 1997;67(8):580–2.

  47. Watkins BJ, Blackmun S, Kuehner ME. Gastric adenocarcinoma after Roux-en-Y gastric bypass: access and evaluation of excluded stomach. Surg Obes Relat Dis. 2007;3:644–7.

    Article  PubMed  Google Scholar 

  48. Swain JM, Adams RB, Farnell MB, et al. Gastric and pancreatoduodenal resection for malignant lesions after previous gastric bypass-diagnosis and methods of reconstruction. Surg Obes Relat Dis. 2010;6:670–5.

    Article  PubMed  Google Scholar 

  49. La Vella E, Yarbrough D. Bile reflux gastritis of the remnant stomach following Roux-en-Y gastric bypass: a newly recognized etiology of chronic abdominal pain successfully treated with remnant gastrectomy. Surg Obes Relat Dis. 2016;12:S56.

    Article  Google Scholar 

  50. Campos J, Neto MG, Martins J, et al. Endoscopic, conservative, and surgical treatment of the gastrogastric fistula: the efficacy of a stepwise approach and its long-term results. Bariatr Surg Pract Patient Care. 2015;10:62–7.

    Article  Google Scholar 

  51. Steinemann DC, Schiesser M, Clavien PA et al. Laparoscopic gastric pouch and remnant resection: a novel approach to refractory anastomotic ulcers after Roux-en-Y Gastric Bypass: Case report. BMC Surg 11, 2011;33.

  52. Ryzhov MK, Zubeev PS, Grekova NS, et al. Case of successful treatment of chronic gastric remnant haemorrhagic ulcer after Roux-en-Y gastric bypass. Obe Metab. 2020;17:88–92.

    Article  Google Scholar 

  53. Tan WH, Eckhouse SR, Dimou F. Intussusception of the gastric remnant following laparoscopic one-anastomosis gastric bypass.  Obes Surg. 2020;30:1586–8.

  54. Gaspar JRR, Marques P, Mesquita I, et al. Laparoscopic treatment of a gastro-gastric fistula after Roux-en-Y gastric bypass—report of two cases. J Surg Case Rep. 2020;2020.

  55. Chinelli J, Hernández G, Rodríguez G. Gastro-gastric fistula: late complication after Roux-en-Y gastric bypass. Obes Surg. 2022;32:2490–1.

    Article  PubMed  Google Scholar 

  56. Lundberg P, El Chaar M. Laparoscopic excision of anastomotic stricture and remnant gastrectomy with conversion to esophago-jejunostomy. Surg Obes Relat Dis. 2018;14:S80.

    Article  Google Scholar 

  57. Chau E, Youn H, Ren-Fielding CJ, et al. Surgical management and outcomes of patients with marginal ulcer after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2015;11:1071–5.

    Article  PubMed  Google Scholar 

  58. Corcelles R, Jamal MH, Daigle CR, et al. Surgical management of gastrogastric fistula. Surg Obes Relat Dis. 2015;11:1227–32.

    Article  PubMed  Google Scholar 

  59. Salimath J, Rosenthal RJ, Szomstein S. Laparoscopic remnant gastrectomy as a novel approach for treatment of gastrogastric fistula. Surg Endosc. 2009;23:2591–5.

    Article  PubMed  Google Scholar 

  60. Rizk S, El Hajj MW, Assaker N, et al. Case report about the management of a late Gastro-Gastric Fistula after Laparoscopic Gastric Bypass, with the finding of an unexpected foreign body. Int J Surg Case Rep. 2020;67:117–9.

    Article  PubMed  PubMed Central  Google Scholar 

  61. O’Brien CS, Wang G, McGinty J, et al. Effects of gastrogastric fistula repair on weight loss and gut hormone levels. Obes Surg. 2013;23:1294–301.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Nascimento WA, Macedo CES, Santa-Cruz F, et al. Gastrointestinal stromal tumor of the excluded stomach after Roux-en-Y gastric bypass: a case report and literature review. Int J Surg Case Rep. 2020;74:196–200.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Pandya SR, Kenney LM, Hughes MS. Gastrointestinal stromal tumor in the excluded gastric remnant after Roux-en-Y gastric bypass. Am Surg. 2023;89:3311–2.

  64. Patrascu S, Ponz CB, Ananin SF, et al. A delayed acute complication of bariatric surgery: gastric remnant haemorrhagic ulcer after Roux-en-Y gastric bypass. J Minim Access Surg. 2018;14(1):68–70.

  65. Abdelsattar JM, McCulloch IL, Abunnaja S. Emergency laparoscopic partial resection of the excluded stomach and gastric pouch in a gastric bypass patient with acute gastrogastric fistula bleeding. Surg Obes Relat Dis. Elsevier Inc. 2020;445–6.

  66. AlZarooni N, Abou Hussein B, Al Marzouqi O, et al. Gastric remnant perforation caused by Peterson’s hernia following one anastomosis gastric bypass: a rare complication. Obes Surg. 2020 ;30:3229–32.

  67. Braley SC, Nguyen NT, Wolfe BM. Late gastrointestinal hemorrhage after gastric bypass. Obes Surg. 2002;12:404–7.

    Article  PubMed  Google Scholar 

  68. Ferreira AJ, Amado F, Trindade C, et al. Anastomotic gastro-jejunal ulcer following one anastomosis gastric bypass (OAGB): laparoscopic conversion to resectional Roux-en-Y gastric bypass (R-RYGB). Obes Surg. 2022;4115–6.

  69. Do PH, Kang YS, Cahill P. Gastric infarction following gastric bypass surgery. J Radiol Case Rep. 2016;10:16–22.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Tinoco A, Gottardi LF, Boechat ED. Gastric cancer in the excluded stomach 10 years after gastric bypass. Case Rep Surg. 2015;2015:1–3.

    Google Scholar 

  71. Magge D, Holtzman MP. Gastric adenocarcinoma in patients with Roux-en-Y gastric bypass: a case series. Surg Obes Relat Dis. 2015;11:e35–8.

    Article  PubMed  Google Scholar 

  72. Raijman, Isaac; Strother, S. Vance Donegan, William L. Gastric cancer after gastric bypass for obesity: case report. J Clin Gastroenterol. 1991;13(2):191–7.

  73. Haenen FW, Gys B, Moreels T, et al. Linitis plastica of the bypassed stomach 7 years after Roux-en-Y gastric bypass: a case report. Acta Chir Belg. 2017;117:391–3.

    Article  PubMed  Google Scholar 

  74. Tucker ON, Szomstein S, Rosenthal RJ. Surgical management of gastro-gastric fistula after divided laparoscopic Roux-en-Y gastric bypass for morbid obesity. J Gastrointest Surg. 2007;11:1673–9.

    Article  CAS  PubMed  Google Scholar 

  75. Chiappetta S, Theodoridou S, Stier C, et al. Incidental finding of GIST during obesity surgery. Obes Surg. 2015;25:579–83.

    Article  PubMed  Google Scholar 

  76. Sánchez Antúnez DJ, Fernández NC, Serrano JO. Unusual case of upper gastrointestinal bleeding after laparoscopic gastric bypass: erosion of gastric remnant involving a diaphragmatic vessel. Surg Obes Relat Dis. 2011;7:328–9.

    Article  PubMed  Google Scholar 

  77. Zefreh H, Amani-Beni R, Sheikhbahaei E, et al. What about my weight? Insufficient weight loss or weight regain after bariatric metabolic surgery. Int J Endocrinol Metab. 2023;21.

  78. Shahabi, Shahab, et al. Resection of gastric fistula and conversion to rygb for gastro pleural fistula after laparoscopic sleeve gastrectomy—a video report. Obes Surg. 2023;33(9):2951–3.

  79. De Luca M, Piatto G, Merola G, et al. IFSO update position statement on one anastomosis gastric bypass (OAGB). Obes Surg. 2021;31:3251–8.

  80. Papasavas PK, Caushaj PF, McCormick JT, et al. Laparoscopic management of complications following laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc Other Interv Tech. 2003;17:610–4.

    CAS  Google Scholar 

  81. Keleidari B, Mahmoudieh M, Shahabi S, et al. Reversing one-anastomosis gastric bypass surgery due to severe and refractory hypoalbuminemia. World J Surg. 2020;44:1200–8.

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We express our gratitude toward Alireza Pouramini and Mahyaar Omouri for their help and support through this project.

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Correspondence to Amirhossein Davarpanah Jazi.

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Key Points

• RGB is indicated when there is a risk of gastric malignancy in remnant.

• Fear of remnant stomach-related complications is another reason for RGB.

• RGB has a comparable weight loss similar to RYGB.

• Gastrogastric fistula, bleeding, ulcer, and neoplasia were reasons of secondary RGB.

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Shahabi Shahmiri, S., Sheikhbahaei, E., Davarpanah Jazi, A. et al. Remnant Gastrectomy and Gastric Bypass: A Systematic Review of Indications and Outcomes of Resectional Gastric Bypass. OBES SURG (2024).

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