Roux-en-Y gastric bypass as a re-do procedure for failed restricive gastric surgery.
BACKGROUND
Gastric restrictive procedures such as laparoscopic gastric banding or vertical banded gastroplasty show, at longer follow up, more and more failures and complications. This study focuses on the results of Roux-en-Y gastric bypass procedure (RYGBP) done as a re-do procedure, both after a technically failed restrictive procedure or when the restrictive procedure failed to obtain substantial weight loss.


METHODS
We reviewed data concerning the postoperative complications and weight loss of 36 patients undergoing re-do surgery for failed restrictive procedures.


RESULTS
Over a period of two years, 36 patients with a mean age of 40.9 years were converted to a RYGBP. Median time to conversion was 4.9 years, median follow up after conversion was 6.6 months. Early postoperative complications (less than 30 days postoperatively) were noted in 11 patients (30%). A greater number of early complications were noticed in group A (technical complications) compared to group B (insufficient weight loss) (39% vs. 22%). Late postoperative complications were seen in six patients (16%). In this relatively short follow up period we noticed a drop in body mass index (BMI) from a mean of 38.8kg/m(2) to 30.9 kg/m(2) with a mean excess body weight loss (EBWL) of 33.1% after the re-do procedure. Body mass index decreased from a mean preoperative value of 37.6kg/m(2) to 28.9 kg/m(2) in group A patients with an EBWL 36%, while group B patients had a change in BMI from 40.1kg/m(2) to 32.9 kg/m(2) with a mean EBWL of 30%.


CONCLUSIONS
Based on the literature, we can presume that restrictive surgery for morbidly obese patients will require many reoperations in the future. The standard operation of choice is RYGBP. In our study this procedure showed a higher, but not significantly early morbidity rate when the indication for re-do surgery was a technical complication of the initial procedure.
Van Dessel
Els
E
Abdominal surgery, Universitair ziekenhuis Antwerpen, Antwerp, Antwerpen, Belgium. vandesselels@msn.com
Hubens
Guy
G
Ruppert
Martin
M
Balliu
Lee
L
Weyler
Joost
J
Vaneerdeweg
Wouter
W
D000328:Adult; D050110:Bariatric Surgery; D015992:Body Mass Index; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D016015:Logistic Models; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation; D017211:Treatment Failure; D016896:Treatment Outcome