title: Outcomes of revisional procedures for insufficient weight loss or weight regain after Roux-en-Y gastric bypass.
abstract: BACKGROUND
  The Roux-en-Y gastric bypass (RYGB) performed laparoscopically (LRYGB) is the most frequently performed bariatric procedure in Belgium. However, late results in terms of weight loss or weight regain are inconsistent and may warrant a second procedure. This retrospective study analyzes the laparoscopic options for revisional surgery after LRYGB.
  
  
  METHODS
  Between January 1, 2001 and December 31, 2009, 70 patients underwent a new laparoscopic procedure for poor weight loss or weight regain after LRYGB. The revisional procedure was performed a median of 2.6 years after the initial bypass operation. Fifty-eight patients were available for follow-up (82.9 %); 19 underwent distalization; and 39 a new restrictive procedure.
  
  
  RESULTS
  The mean mass index (BMI) before the revisional procedure was 39.1 + 11.3 kg/m(2) (30.8-51.8), down from 42.7 + 19.7 kg/m(2) (33.0-56.6) initially, which corresponded to a percentage of excess weight loss (EWL) of 12.4 + 9.3 % (-1.0-29.1). After the corrective procedure, with a follow-up of approximately 4 years, mean BMI was 29.6 + 12.4 kg/m(2) (18.0-45.5), for a significant additional percentage of EWL of 53.7 + 9.8 % (2.0-65.8). The overall complication rate was 20.7 %, and the reoperation rate was 7.3 %. The overall leak rate was 12.1 %. Patients suffering from leaks could consistently be treated conservatively or by stent placement. Two patients needed reconversion after distal bypass. The satisfaction index was good in just over 50 % of the patients.
  
  
  CONCLUSIONS
  Revisional laparoscopic surgery after RYGB performed for weight issues provides good additional weight loss but carries significant morbidity. Leaks can usually be handled non-surgically. Patient satisfaction is only fair.
authors.affiliation: The European School of Laparoscopy, St Blasius General Hospital, Dendermonde, Belgium. Jacques_himpens@hotmail.com
authors.forename: Jacques
authors.initials: J
authors.lastname: Himpens
authors.forename: Laia
authors.initials: L
authors.lastname: Coromina
authors.forename: Anneleen
authors.initials: A
authors.lastname: Verbrugghe
authors.forename: Guy-Bernard
authors.initials: GB
authors.lastname: Cadière
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000503:physiopathology / Q000601:surgery*; D017060:Patient Satisfaction; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D015430:Weight Gain; D015431:Weight Loss; D055815:Young Adult