Published in:
01-02-2017 | Original Contributions
Pouch Reshaping for Significant Weight Regain after Roux-en-Y Gastric Bypass
Published in: Obesity Surgery | Issue 2/2017
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Background
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.
Methods
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.
Results
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/m2 and 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).
Conclusions
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.