title: Pouch Reshaping for Significant Weight Regain after Roux-en-Y Gastric Bypass.
abstract: Significant weight regain after Roux-en-Y gastric bypass (RYGB) occurs in around 20 % of patients in the long term. Anatomical reasons include dilatation of the gastric pouch and/or the pouch-jejunal anastomosis, leading to loss of restriction. Pouch reshaping (PR) aims at reestablishing restriction with a subsequent feeling of satiety. This study reports the outcome of PR embedded in a multidisciplinary treatment pathway.
  
  
  
  Twenty-six patients after PR for weight regain >30 % following RYGB in a university hospital between October 2010 and March 2016 were analyzed. Excluded were patients with PR for gastro-gastric fistulae, hypoglycemia, candy cane syndrome, and concomitant alteration of limb lengths. PR consisted in laparoscopic lateral resection of the gastric pouch, the anastomosis and the proximal 5 cm of the alimentary limb over a 32F bougie.
  
  
  
  Median follow-up after PR was 48 months (range 24-60). Median BMI at PR was 39.1 kg/m2(32.7-59.1). Median operation time was 85 min (25-190), and median length of stay was 3 days (1-35). Minor complications (grade ≤ 2) occurred in seven (27 %) patients and major complications (grade ≥ 3) in four patients (15 %). Nadir BMI and %EBMIL after PR were 32.9 kg/m2and 43.3 %, reached after a median of 12 months (3-48). Comorbidities were resolved in 81 %. After 48 months, median BMI was 33.8 kg/m2(20.4-49.2) and %EBMIL was 61.4 (39.1-121.2).
  
  
  
  Used selectively in a multidisciplinary treatment pathway, PR leads to prolonged weight stabilization around the previous nadir. However, its associated perioperative morbidity must not be disregarded.
authors: Department of Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, 3010, Bern, Switzerland. yves.borbely@insel.ch.
authors: Yves
authors: Y
authors: Borbély
authors: Department of Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, 3010, Bern, Switzerland.
authors: Carmen
authors: C
authors: Winkler
authors: Department of Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, 3010, Bern, Switzerland.
authors: Dino
authors: D
authors: Kröll
authors: Department of Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, 3010, Bern, Switzerland.
authors: Philipp
authors: P
authors: Nett
mesh_terms: D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D013270:Stomach / Q000601:surgery*; D016896:Treatment Outcome; D015430:Weight Gain
keywords: *Gastric bypass/methods; Body mass index; Humans; Laparoscopy; Obesity, morbid/surgery; Pouch reshaping; Pouch resizing; Reoperation; Revisional bariatric surgery; Roux-en-Y gastric bypass; Surgery; Weight gain; Weight loss; Weight recidivism; Weight regain