title: Revision Roux-en-Y Gastric Bypass to Biliopancreatic Long-Limb Gastric Bypass for Inadequate Weight Response: Case Series and Analysis.
abstract: The long-limb Roux-en-Y gastric bypass (LLRYGB) was introduced in 1987 as a salvage operation for inadequate weight loss after a standard Roux-en-Y gastric bypass (RYGB).
  
  
  
  We report on 53 consecutive patients (44 females) with conversion of a failed RYGB to a LLRYGB performed by a single surgeon between 2002 and 2014. No patient had an ascertainable anatomic abnormality to explain his/her weight regain. LLRYGB revision consisted of a 75-cm to 100-cm alimentary Roux limb and a 75-cm to 100-cm common channel; after 2011, in suitable patients, the Roux limb was lengthened to greater than 250 cm.
  
  
  
  Average values for weight (lbs) were as follows: pre-original RYGB = 329; lowest measured after RYGB = 196; at time of LLRYGB = 285; and at 1, 2, 3, 4, >5 years post LLRYGB = 225, 207, 199, 197, 195, for a sustained weight loss >90 lbs. Average values for BMI (kg/m2) were as follows: pre-original RYGB = 54.3; lowest measured after RYGB = 32.3; at time of LLRYGB = 47.2; and at 1, 2, 3, 4, >5 years post LLRYGB = 37.1, 34.4, 33.0, 32.8, 31.4, for a sustained BMI reduction >16.5 kg/m2. Zero operative mortality; 3 (5.7%) late deaths; 7 (13.2%) 30-day complications; 33 (62.3%) long-term complications with 23 (43.4%) needing TPN; and 14 (26.4%) requiring operative revision.
  
  
  
  A salvage LLRYGB procedure can be performed safely and is weight successful, but fraught with long-term nutritional problems and a high necessity for revision. A Roux segment over 250 cm may improve outcomes.
authors.affiliation: Department of Surgery, University of Minnesota, 420 Delaware Street SE, MMC 195, Minneapolis, MN, 55455, USA. buchw001@umn.edu.
authors.forename: Henry
authors.initials: H
authors.lastname: Buchwald
authors.affiliation: Department of Surgery, University of Minnesota, 420 Delaware Street SE, MMC 195, Minneapolis, MN, 55455, USA.
authors.forename: Danette M
authors.initials: DM
authors.lastname: Oien
mesh_terms: D000328:Adult; D015904:Biliopancreatic Diversion / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D015390:Gastric Bypass / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D010359:Patient Readmission / Q000706:statistics & numerical data; D012086:Reoperation / Q000379:methods* / Q000706:statistics & numerical data; D017211:Treatment Failure; D015431:Weight Loss
keywords: Failed weight loss after Roux-en-Y gastric bypass (RYGB); Long-limb Roux-en-Y gastric bypass (LLRYGB); Revision after RYGB