title: Reversal to normal anatomy after failed gastric bypass: systematic review of indications, techniques, and outcomes.
abstract: BACKGROUND
  Roux-en-Y gastric bypass (RYGB) is one of the most common and most effective procedures performed to combat obesity and obesity-related metabolic disease. In a small proportion of patients, however, complications may necessitate the attempted reversal of RYGB to normal anatomy. The indications for this procedure, as well as technique, complication rate, and success in resolving symptoms are not clearly defined.
  
  
  OBJECTIVE
  To assess current literature describing outcomes after reversal of RYGB.
  
  
  METHODS
  A systematic search of online databases was conducted. Two independent researchers identified and extracted data for studies describing outcomes after RYGB reversal surgery. Indications, techniques, and outcomes were compared, with results pooled where possible.
  
  
  RESULTS
  Eight articles were included in the final data synthesis, incorporating data for 46 patients. Reversal was undertaken due to metabolic, physical, nutritional, or other complications. All successfully underwent RYGB reversal with no reported mortality. Surgical technique varied greatly across the included studies. Postoperative morbidity was high, with 42% suffering complications (56% of which were major). Symptom relief or improvement was achieved in 82% of cases.
  
  
  CONCLUSIONS
  Reversal of RYGB may be undertaken for a variety of indications after RYGB. Though this may successfully eliminate or improve symptoms in a large proportion of patients, the risk of morbidity is high. Surgery should be undertaken after careful patient selection and in appropriately skilled centers only.
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, United Kingdom. Electronic address: p.pucher@imperial.ac.uk.
authors.forename: Philip H
authors.initials: PH
authors.lastname: Pucher
authors.affiliation: Department of Surgery, Southampton General Hospital, Southampton, United Kingdom.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Lord
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, United Kingdom.
authors.forename: Mikael H
authors.initials: MH
authors.lastname: Sodergren
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, United Kingdom.
authors.forename: Ahmed R
authors.initials: AR
authors.lastname: Ahmed
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, United Kingdom.
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, United Kingdom.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Purkayastha
mesh_terms: D000328:Adult; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D055815:Young Adult
keywords: gastric bypass; normalisation; obesity; reversal; revision