title: Laparoscopic "gastrojejunal sleeve reduction" as a revision procedure for weight loss failure after roux-en-y gastric bypass.
abstract: BACKGROUND
  Weight regain after Roux-en-Y gastric bypass (RYGB) is increasingly reported in the bariatric literature. Laparoscopic sleeve reduction of the gastrojejunal complex is a surgical option to revise a dilated gastric pouch. We report our short-term results.
  
  
  METHODS
  Sleeve reduction entails serial firing of a linear stapler along the jejunal alimentary limb, across the gastric pouch and towards the left crus, with a bougie in place, thus, creating a new 20-25-cm reduced gastrojejunal complex. Data analyzed included age, body mass index (BMI), excess weight loss (EWL), comorbidity resolution, and any other simultaneous operative procedures.
  
  
  RESULTS
  Fourteen patients were identified, all done laparoscopically. Nine underwent gastrojejunal sleeve reduction alone and five underwent additional lengthening of the Roux limb. There were no mortalities. Mean age at revision was 43 years (31-59). Mean BMI and EWL prior to revision were 35.5 ± 4.0 kg/m² and 48.9 ± 15.8%, respectively. Nine of 14 patients (64%) had obesity-related comorbidities prior to the revision. Average BMI decrease was 2.7 kg/m². Post-revision mean BMI and %EWL were 32.9 ± 4.7 kg/m² and 12.0 ± 13.9%, respectively, with mean follow-up of 12 months. Three of nine patients (33%) experienced improvement and/or resolution of comorbidities. We did not find a significant difference between pre-and post-revision mean BMI and %EWL (p = 0.13) even after separately evaluating those patients who underwent Roux limb lengthening (p = 0.16).
  
  
  CONCLUSIONS
  For RYGB patients who regained weight, laparoscopic gastrojejunal sleeve reduction does not seem to offer a major therapeutic benefit. Additional malabsorptive Roux lengthening also does not provide a significant benefit. Other options should be considered, such as placing a band on the gastric pouch or conversion to duodenal switch.
authors.affiliation: Laparoscopic and Bariatric Surgery, Department of Surgery, Weill College of Medicine of Cornell University, New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Manish
authors.initials: M
authors.lastname: Parikh
authors.forename: Laura
authors.initials: L
authors.lastname: Heacock
authors.forename: Michel
authors.initials: M
authors.lastname: Gagner
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000379:methods*; D015992:Body Mass Index; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000379:methods; D017792:Surgical Stapling; D015431:Weight Loss