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Obesity Surgery
Published in: Obesity Surgery 3/2018

01-03-2018 | Original Contributions

Medium-Term Outcomes after Reversal of Roux-en-Y Gastric Bypass

Authors: Gustavo Andrés Arman, J. Himpens, R. Bolckmans, D. Van Compernolle, R. Vilallonga, G. Leman

Published in: Obesity Surgery | Issue 3/2018

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Abstract

Background

Roux-en-Y gastric bypass (RYGB) can be reversed into normal anatomy (NA) or into sleeve gastrectomy (NASG) to address undesired side effects. Concomitant hiatal hernia repair (HHR) may be required. Before reversal, some patients benefit from placement of a gastrostomy, mostly to predict the result of recreating the native anatomy.

Methods

Retrospective study on mid-term effects of RYGB reversal to NA and NASG, including clinical and weight evolution, surgical complications, and incidence of gastro-esophageal reflux (GERD).

Results

Undesired side effects leading to reversal included early dumping syndrome, hypoglycemia, malnutrition, severe diarrhea and excessive nausea and vomiting. Twenty-five participants to the study, 13 NA, 12 NASG, and 15 HHR. Mean follow-up time was 5.3 ± 2.3 years. Reversal corrected early dumping, malnutrition, diarrhea, and nausea/vomiting. For hypoglycemic syndrome, resolution rate was 6/8 (75%). NA caused significant weight regain (14.2 ± 13.7 kg, (p = .003)). NASG caused some weight loss (4.8 ± 15.7 kg (NS)). Gastrostomy placement gave complications at reversal in five of seven individuals. Eight patients suffered a severe complication, including leaks (one NA vs. three NASGs). Eight out of 14 (57.1%) patients who previously had never experienced GERD developed de novo GERD after reversal, despite HHR.

Conclusions

RYGB reversal is effective but pre-reversal gastrostomy and concomitant HHR may be aggravating factors for complications and development of de novo GERD, respectively.
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Metadata
Title
Medium-Term Outcomes after Reversal of Roux-en-Y Gastric Bypass
Authors
Gustavo Andrés Arman
J. Himpens
R. Bolckmans
D. Van Compernolle
R. Vilallonga
G. Leman
Publication date
01-03-2018
Publisher
Springer US
Published in
Obesity Surgery / Issue 3/2018
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-017-2928-7

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