title: Outcomes of revisional treatment modalities in non-complicated Roux-en-Y gastric bypass patients with weight regain.
abstract: BACKGROUND
  Laparoscopic Roux-en-Y gastric bypass (RYGB) is an effective treatment modality for severe obesity. Failure of weight loss and/or weight regain due to lack of restriction has been reported in long-term follow-up studies. The aim of this study is to determine the safety and effectiveness of reestablishing the restrictive component of the operation by trimming the pouch and/or anastomosis for pouch and/or anastomotic enlargement using a laparoscopic approach.
  
  
  METHODS
  We retrospectively reviewed our prospectively collected database for all patients that underwent revisional surgery of RYGB for weight regain or failure of weight loss. Percent excess weight loss (%EWL) and BMI loss (BMIL) were characterized into the following three time periods: (1) primary operation to pre-revision, (2) pre-revision to post-revision, and (3) primary operation to post-revision. Post-operative follow-up was at 6, 12, 18, 24, 36, and 48 months.
  
  
  RESULTS
  Between 2005 and 2011, a total of 121 patients in the database underwent revision of RYGB. Forty-four patients were identified that fulfilled the aforementioned parameters. In this group, 30 patients underwent trimming of the pouch and/or redo anastomosis (TPA), 8 TPA and conversion from retrocolic to antecolic Roux limb, and 6 TPA with remnant gastrectomy. Mean follow-up period was 26.1 ± 22.7 months. The post-revision mean %EWL was 38%, and the BMI loss was 7 kg/m(2). In the pre-revision to 48 months post-revision time period, mean %EWL and BMIL were 28.6% and 4.9 kg/m(2) in the TPA-only group, 52% and 8.8 kg/m(2) in the TPA with conversion to antecolic, antegastric group, and 33.4% and 5.9 kg/m(2) in the TPA with gastrectomy group, respectively (%EWL, p = 0.096; BMIL, p = 0.227). One patient (2.3%) developed a left upper quadrant hematoma. There was no mortality in this series.
  
  
  CONCLUSIONS
  Trimming of the pouch and/or anastomosis appears to be a safe and effective revisional modality for patients with insufficient weight loss or weight regain after gastric bypass in the hands of experienced surgeons.
authors.affiliation: The Bariatric and Metabolic Institute and Section of Minimally Invasive Surgery, Department of General Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
authors.forename: David
authors.initials: D
authors.lastname: Nguyen
authors.forename: Fernando
authors.initials: F
authors.lastname: Dip
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Huaco
authors.forename: Rena
authors.initials: R
authors.lastname: Moon
authors.forename: Hira
authors.initials: H
authors.lastname: Ahmad
authors.forename: Emanuele
authors.initials: E
authors.lastname: LoMenzo
authors.forename: Samuel
authors.initials: S
authors.lastname: Szomstein
authors.forename: Raul
authors.initials: R
authors.lastname: Rosenthal
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D061887:Conversion to Open Surgery; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011184:Postoperative Period; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D015430:Weight Gain