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Revisional Bariatric Surgery After Roux-en-Y Gastric Bypass for Bile Reflux: a Single-Center Long-Term Cohort Study

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Revisional bariatric surgery (RBS) after primary Roux-en-Y gastric bypass (RYGB) is indicated for the efficient management of specific complications such as bile reflux. Published literature on this topic remains scarce as we aim to evaluate the long-term outcomes (10 years) of RBS for bile reflux after RYGB.

Material and Methods

We conducted a single-center retrospective study of patients who underwent primary RYGB complicated by bile reflux and had RBS between 2008 and 2023. Our cohort was divided into two groups based on the etiology of bile reflux. Long-term surgical outcomes and nutritional status were reported and compared between the groups.


A total of 41 patients (100% primary RYGB; 90.2% female, 97.6% white) were included. 56.1% (n = 23) of patients underwent Roux limb lengthening and the remaining 43.9% (n = 18) had a gastrogastric fistula takedown, with no significant differences in terms of intraoperative complications, estimated blood loss (p = 0.616), length of hospital stay (p = 0.099), and postoperative complications between the two groups. Long-term resolution of obesity-related medical conditions was demonstrated for all the evaluated comorbidities. Lastly, there was no reported mortality, bile reflux recurrence, or micro- and macro-nutrient deficiencies over the total follow-up period of 10 years.


In our cohort, RBS after a primary RYGB for bile reflux management demonstrated safe and efficient short- and long-term surgical outcomes without any reported bile reflux recurrence or mortality. Adequate supplementation and close patient follow-up remain essential to decrease the morbidity and mortality associated with RBS as further studies are required to support our findings.

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Data Availability

The data that support the findings of this study are available upon reasonable request from the corresponding author.


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Correspondence to Omar M. Ghanem.

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Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

IRB Approval

This study was deemed exempt by the Institutional Review Board.

Conflict of Interest

Barham K. Abu Dayyeh has received consulting fees from Endogenex, Endo-TAGSS, Metamodix, and BEKW; Consulting fee and grant/research support from USGI, Cairn Diagnostics, Aspire Bariatrics, Boston Scientific; Speaker honorarium from Olympus, Johnson and Johnson; speaker honorarium and grant/research support from Medtronic, Endogastric solutions; and research/support grant from Apollo Endosurgery, and Spatz. Medical.

Omar M. Ghanem is a consultant for Olympus, Regeneron and Medtronic.

All other authors declare no conflicts of interest.

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Key Points

• Short Roux limb and gastrogastric fistula are two causes of bile reflux after RYGB.

• RBS showed favorable outcomes in patients who develop bile reflux after RYGB.

• Appropriate RBS is associated with low mortality and bile reflux recurrence rates.

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Hage, K., Sawma, T., Jawhar, N. et al. Revisional Bariatric Surgery After Roux-en-Y Gastric Bypass for Bile Reflux: a Single-Center Long-Term Cohort Study. OBES SURG 34, 2420–2430 (2024).

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