Laparoscopic reconversion of Roux-en-Y gastric bypass to original anatomy: technique and preliminary outcomes.
BACKGROUND
Laparoscopic Roux-en-Y gastric bypass (RYGB) is one of the most common bariatric procedures performed. Dumping syndrome, intolerance to RYGB-induced restriction, and weight loss issues are possible problems bariatric surgeons are confronted with. This study reports the feasibility, safety, and outcomes of laparoscopic reconversion of RYGB to original anatomy (OA) as treatment of these complications.


METHODS
Between January 2005 and April 2008, eight patients benefited from laparoscopic reconversion of RYGB to OA. Reason was dumping syndrome without postprandial hypoglycemia (three), intolerance to RYGB-induced restriction (three), too much (one) and too little weight loss (one). Mean weight and body mass index (BMI) at RYGB were 104.7±19.3 kg and 38.7±6 kg/m(2), respectively. Four patients suffered of obesity co-morbidities. Mean time between RYGB and reconversion was 21±18.8 months. Mean weight, BMI, and % excess weight loss at reconversion was 66.8±21.7 kg, 20.1±7 kg/m(2), and 23.7±55%, respectively. The procedure involved dismantling both gastrojejunostomy and jejunojejunostomy, reanastomosing gastric pouch to gastric remnant, and proximal alimentary limb end to distal biliary limb end.


RESULTS
Mean operative time was 132.2±29.5 min. There were no conversions to open surgery and no early complications. Gastrogastrostomy was performed manually (four) and by linear stapler (four), and jejunojejunostomy by linear stapler (eight). Mean hospital stay was 7.7±3.5 days. After a mean follow-up of 18.3±9.2 months, two patients continued to further lose weight, two patients maintained the same weight, and four patients presented weight regain. Gastroesophageal reflux disease appeared in three patients.


CONCLUSIONS
Laparoscopic reconversion of RYGB to OA is feasible and safe. Dumping syndrome and intolerance to RYGB-induced restriction are resolved. The anatomy remains one of the aspects besides nutritional and psychological factors in cases of reconversion for weight issues.
Dapri
Giovanni
G
Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium. giovanni@dapri.net
Cadière
Guy Bernard
GB
Himpens
Jacques
J
D000328:Adult; D003251:Constriction, Pathologic / Q000601:surgery; D004377:Dumping Syndrome / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D016896:Treatment Outcome; D015430:Weight Gain; D015431:Weight Loss
Curr Opin Clin Nutr Metab Care. 2006 Jul;9(4):423-35
16778572
Ann Surg. 1962 Oct;156:537-49
14029328
Obes Surg. 2003 Aug;13(4):596-600
12935361
Arch Surg. 2006 Mar;141(3):247-51
16549689
N Engl J Med. 2005 Jul 21;353(3):249-54
16034010
Eur J Endocrinol. 2007 Aug;157(2):157-66
17656593
Obes Surg. 2006 Jul;16(7):908-12
16839492
Surg Obes Relat Dis. 2010 Jan-Feb;6(1):36-40
19560979
Obes Surg. 2000 Apr;10(2):183-5
10782184
JAMA. 2004 Oct 13;292(14):1724-37
15479938
Nutrition. 2008 Jun;24(6):604-6
18359196
J Clin Endocrinol Metab. 2008 Dec;93(12):4656-63
18765510
Obes Surg. 2008 Aug;18(8):981-8
18438618
Surg Obes Relat Dis. 2007 Jul-Aug;3(4):423-7
17544923
Surg Obes Relat Dis. 2008 Jul-Aug;4(4):492-9
18656831
Nutr Clin Pract. 2005 Oct;20(5):517-25
16207692
Am J Surg. 1965 Jan;109:7-13
14248301
Ann Surg. 1995 Sep;222(3):339-50; discussion 350-2
7677463
Ann Surg. 2006 Nov;244(5):734-40
17060766
Surgery. 1960 Jul;48:185-94
14422271
Obes Surg. 2008 Dec;18(12):1622-4
18941845
Obes Surg. 2011 Jan;21(1):29-35
19847571
Diabetologia. 2005 Nov;48(11):2236-40
16195867
Surg Obes Relat Dis. 2007 Nov-Dec;3(6):611-8
17936087