title: Gastric bypass reversal: a 7-year experience.
abstract: BACKGROUND
  After gastric bypass, some patients develop conditions that ultimately require reversal of the bypass. There are currently few publications on the topic to guide clinicians.
  
  
  OBJECTIVE
  To describe the indications, techniques, and outcomes for gastric bypass reversal.
  
  
  METHODS
  Two academic medical centers.
  
  
  METHODS
  We conducted a retrospective chart review of all patients who underwent gastric bypass reversal at our institutions between 2008 and 2015. Information regarding the original operation, the indications for reversal, procedures performed, and the postoperative outcomes were collected and analyzed.
  
  
  RESULTS
  Nineteen patients underwent gastric bypass reversal. All but 4 reversal operations were performed laparoscopically. The indications for reversal were malnutrition or excessive weight loss (6 patients); chronic nausea, vomiting, and abdominal pain (5); neuroglycopenia (4); massive small bowel loss due to internal hernia (3); and need for surveillance gastric endoscopy (1). In the perioperative period, 4 patients had a complication that required intervention. Five patients required additional delayed procedures. One patient was lost to follow-up. The remaining patients' mean follow-up was 22±18 months. Symptoms that prompted reversal of the gastric bypass resolved in the majority of patients. However, 1 patient's hypoglycemia did not resolve and 2 continued to have diarrhea. Six patients were weaned off of total parenteral nutrition.
  
  
  CONCLUSIONS
  Laparoscopic gastric bypass reversal is feasible and well tolerated. The procedure can be employed to treat a variety of conditions that may occur after gastric bypass and the majority of patients benefit, with resolution of symptoms. In a carefully selected patient population, gastric bypass reversal should be considered if conservative approaches to adverse conditions fail.
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Boston, MA.
authors.forename: Luise I M
authors.initials: LI
authors.lastname: Pernar
authors.affiliation: Department of Surgery, Tufts Medical Center, Boston, MA.
authors.forename: Julie J
authors.initials: JJ
authors.lastname: Kim
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Boston, MA. Electronic address: sshikora@partners.org.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Shikora
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D000069290:Incisional Hernia / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000601:surgery / Q000628:therapy; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D010288:Parenteral Nutrition / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D020250:Postoperative Nausea and Vomiting / Q000209:etiology; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology
keywords: Complications; Gastric bypass; Laparoscopic; Malnutrition; Reversal