Laparoscopic conversion of Roux-en-Y gastric bypass to distal gastric bypass for weight regain.
BACKGROUND
Weight regain after Roux-en-Y gastric bypass (RYGB) is one of the possible complications bariatric surgeons are confronted with. An option for enhancing weight loss is the conversion of RYGB into distal RYGB (DRYGB), which is a malabsorptive procedure. We report the technical strategy and the preliminary outcomes of conversion of RYGB to DRYGB by laparoscopy.


METHODS
Between April 2005 and November 2009, 7 patients benefited from laparoscopic conversion of RYGB to DRYGB for weight regain mainly due to a new dietary behavior, namely, polyphagia (eating too frequent meals). At the time of RYGB, the mean weight and BMI was 120.5 ± 26.4 kg and 43.2 ± 6.7 kg/m(2), respectively. Five patients suffered of obesity-related comorbidities. Mean interval time between RYGB and conversion was 41 ± 15.9 months. At the time of conversion, the mean weight, BMI, % excess weight loss were 100.7 ± 19.8 kg, 36.1 ± 4.8 kg/m(2), and 33.7% ± 12.1%, respectively. Obesity-related comorbidities at that time affected 4 patients.


RESULTS
Mean operative time was 122.1 ± 34 minutes. There were no conversions to open surgery and no mortality. Postoperatively, 1 patient suffered of a bleeding. Mean hospital stay was 4.7 ± 2.5 days. After a mean follow-up of 19 ± 23.7 months, the mean weight, BMI, and % excess weight loss was 82.5 ± 19.7 kg, 29.5 ± 5.3 kg/m(2), and 57.6% ± 8.1%, respectively. Obesity-related comorbidities remained unchanged after the conversion in the 4 patients. One patient required a surgical reoperation for internal hernia.


CONCLUSIONS
Conversion of RYGB to DRYGB for weight regain can safely be performed by laparoscopy, with satisfactory early results.
Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium. giovanni@dapri.net
Giovanni
G
Dapri
Guy Bernard
GB
Cadière
Jacques
J
Himpens
D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D015430:Weight Gain