title: Management of Excessive Weight Loss Following Laparoscopic Roux-en-Y Gastric Bypass: Clinical Algorithm and Surgical Techniques.
abstract: BACKGROUND
  There are no clinical guidelines or published studies addressing excessive weight loss and protein calorie malnutrition following a standard Roux-en-Y gastric bypass (RYGB) to guide nutritional management and treatment strategies. This study demonstrates the presentation, clinical algorithm, surgical technique, and outcomes of patients afflicted and successfully treated with excessive weight loss following a standard RYGB.
  
  
  METHODS
  Three patients were successfully reversed to normal anatomy after evaluation, management, and treatment by multidisciplinary team. Lowest BMI (kg/m(2)) was 18.9, 17.9, and 14.2, respectively.
  
  
  RESULTS
  Twelve-month post-operative BMI (kg/m(2)) was 28.9, 22.8, and 26.1, respectively. Lowest weight (lbs) was 117, 128, and 79, respectively. Twelve-month post-operative weight (lbs) was 179, 161, and 145, respectively. Pre-reversal gastrostomy tube was inserted into the remnant stomach to demonstrate weight gain and improve nutritional status prior to reversal to original anatomy.
  
  
  CONCLUSIONS
  We propose a practical clinical algorithm for the work-up and management of patients with excessive weight loss and protein calorie malnutrition after standard RYGB including reversal to normal anatomy.
authors.affiliation: Department of General Surgery, Division of Bariatric Surgery, St. Luke's University Health Network, Allentown, PA, USA.
authors.forename: Ikemefuna
authors.initials: I
authors.lastname: Akusoba
authors.affiliation: Department of General Surgery, Division of Bariatric Surgery, St. Luke's University Health Network, Allentown, PA, USA.
authors.forename: T Javier
authors.initials: TJ
authors.lastname: Birriel
authors.affiliation: Department of General Surgery, Division of Bariatric Surgery, St. Luke's University Health Network, Allentown, PA, USA. Maher.Elchaar@sluhn.org.
authors.forename: Maher
authors.initials: M
authors.lastname: El Chaar
mesh_terms: D000328:Adult; D000465:Algorithms; D015992:Body Mass Index; D019468:Disease Management; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D018530:Gastric Stump / Q000601:surgery; D005774:Gastrostomy; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011502:Protein-Energy Malnutrition / Q000209:etiology / Q000601:surgery; D012086:Reoperation / Q000379:methods; D016896:Treatment Outcome; D015431:Weight Loss
keywords: Excessive weight loss; Gastric bypass reversal; Protein calorie malnutrition; Roux-en-Y gastric bypass