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Langenbeck's Archives of Surgery

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01-12-2017 | How-I-Do-It Articles

Laparoscopic reversal of mini-gastric bypass to original anatomy for severe postoperative malnutrition

Authors: Laurent Genser, Antoine Soprani, Malek Tabbara, Jean-Michel Siksik, Jean Cady, Sergio Carandina

Published in: Langenbeck's Archives of Surgery | Issue 8/2017

Abstract

Purpose

Malnutrition after mini-gastric bypass (MGB) is a rare and dreaded complication with few data available regarding its surgical management. We aim to report the feasibility, safety, and results of laparoscopic reversal of MGB to normal anatomy (RMGB) in case of severe and refractory malnutrition syndrome after intensive nutritional support (SRMS).

Methods

A 10-year retrospective chart review was performed on patients who underwent RMGB (video included) for SRMS following MGB.

Results

Twenty-six of 2934 patients underwent a RMGB at a mean delay of 20.9 ± 13.4 months post-MGB. At presentation, mean body mass index (BMI), excess weight loss (%EWL), and albumin serum level were 22 ± 4.4 kg/m², 103.6 ± 22.5%, and 25.5 ± 3.6 gr/L, respectively. Seventeen (63.5%) patients had at least one severe malnutrition related complication including severe edema in 13 (50%), venous ulcers in 2 (7.7%), infectious complications in 7 (27%), deep venous thrombosis in 5 (19.2%), and motor deficit in 5 (19.2%) patients. At surgical exploration, 8 of 12 (66.5%) patients had a biliary limb longer than 200 cm and 9 (34.6%) had bile reflux symptoms. Overall morbidity was 30.8% but lower when resecting the entire previous gastrojejunostomy with creation of a new jejunojejunostomy (8.3 vs 50%, p = 0.03). After a mean follow-up of 8 ± 9.7 months, all patients experienced a complete clinical and biological regression of the SRMS after the RMGB despite a mean 13.9 kg weight regain in 16 (61.5%) patients.

Conclusions

Post-MGB SRMS and its related comorbidities are rare but dreaded conditions. Although burdened by a significant postoperative morbidity and weight regain, RMGB remains an effective option to consider, when intensive nutritional support fails.

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Title: Laparoscopic reversal of mini-gastric bypass to original anatomy for severe postoperative malnutrition
Authors: Laurent Genser
Antoine Soprani
Malek Tabbara
Jean-Michel Siksik
Jean Cady
Sergio Carandina
Publication date: 01-12-2017
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 8/2017
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-017-1615-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Laparoscopic reversal of mini-gastric bypass to original anatomy for severe postoperative malnutrition

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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