title: Laparoscopic hand-sewn revisional gastrojejunal plication for weight loss failure after Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Revisional surgery has become a widely accepted alternative for weight loss failure/regain after bariatric surgery. However, it is associated to higher morbi-mortality and lesser weight loss than primary bariatric procedure. Our aims are to present a novel technique for weight loss treatment after failed laparoscopic Roux-en-Y gastric bypass (LRYGB) and to report its short-term results.
  
  
  METHODS
  This is a retrospective analysis of patients submitted to a revisional hand-sewn double-layer gastrojejunal plication (GJP) for treatment of weight loss failure/regain after LRYGB. Analysis of demographics, body mass index (BMI), and percentage of excess weight loss (%EWL) at the 6th month complications, and financial costs involved was included.
  
  
  RESULTS
  Four patients were submitted to revisional GJP. Three patients were female and the mean age at revision was 30 ± 9 years (21-44). The median time interval between LRYGB and GJP was 51 months (24-120). The median BMI at the moment of GJP and the 3rd and 6th month was 35.6 kg/m2 (32.0-37.8), 32.2 kg/m2 (29.7-34.1), and 30.7 kg/m2 (28.1-32.1), respectively. The median %EWL at the 3rd and 6th month was 35.4% (13.6-38.9) and 46.2 % (45.1-55.5), respectively, reaching a cumulative (combined surgeries) %EWL of 62.9% (16.5-67.9) and 71.7% (65.1-77.6), respectively. There were no complications or mortality. Financial costs were significantly lower compared to revisional gastrojejunal stapled reduction (US $1400 cheaper).
  
  
  CONCLUSIONS
  Revisional GJP is a feasible, safe, and cost-effective novel procedure for treatment of weight loss failure/regain after LRYGB. Mid- and long-term results are necessary in order to establish its real effectiveness.
authors.affiliation: Bariatric Surgery Unit, Digestive Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, patio interior, División de Cirugía, Región Metropolitana, Santiago, Chile, felipeleon81@gmail.com.
authors.forename: Felipe
authors.initials: F
authors.lastname: León
authors.forename: Cristóbal
authors.initials: C
authors.lastname: Maiz
authors.forename: David
authors.initials: D
authors.lastname: Daroch
authors.forename: Nicolás
authors.initials: N
authors.lastname: Quezada
authors.forename: Mauricio
authors.initials: M
authors.lastname: Gabrielli
authors.forename: César
authors.initials: C
authors.lastname: Muñoz
authors.forename: Camilo
authors.initials: C
authors.lastname: Boza
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data; D017048:Health Care Costs; D006801:Humans; D007581:Jejunoileal Bypass / Q000191:economics / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D010535:Laparoscopy / Q000191:economics / Q000379:methods; D008297:Male; D009767:Obesity, Morbid / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D012086:Reoperation / Q000191:economics / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D013536:Suture Techniques / Q000191:economics; D013537:Sutures / Q000191:economics; D017211:Treatment Failure; D015431:Weight Loss; D055815:Young Adult