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Obesity Surgery
Published in: Obesity Surgery 4/2018

01-04-2018 | Original Contributions

Revisional Gastric Bypass for Failed Restrictive Procedures: Comparison of Single-Anastomosis (Mini-) and Roux-en-Y Gastric Bypass

Authors: Owaid M. Almalki, Wei-Jei Lee, Jung-Chien Chen, Kong-Han Ser, Yi-Chih Lee, Shu-Chun Chen

Published in: Obesity Surgery | Issue 4/2018

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Abstract

Background

Ten to 50% of patients who received restrictive bariatric operations may require reoperation for unsatisfactory weight loss or weight regain. Failed restrictive procedures are usually managed with conversion to another bariatric procedure with a favor of conversion to laparoscopic gastric bypass. Our aim is to evaluate two different bypass techniques, laparoscopic RY gastric bypass (RYGB) versus single-anastomosis (mini-) gastric bypass (SAGB) as a revision option (R-RYGB and R-SAGB) for failed restrictive bariatric operations.

Material and Methods

From May 2001 to December 2015, a total of 116 patients with failed restrictive bariatric operations underwent laparoscopic revisional bypass surgery (81 R-SAGB and 35 R-RYGB). Among them, 81 were failed after vertical banded gastroplasty (VBG) and 35 were after adjustable gastric band (AGB). The demographic data, surgical parameters, and outcomes were studied.

Results

The average age at revision surgery was 35.7 years (range 22–56), and the average body mass index (BMI) before reoperation was 37.2 kg/m2 (29.0–51.8). Revision surgery was performed after 58.8 months from the primary surgery on average (14–180 months). The main reasons for the revisions were weight regain (50.9%), inadequate weight loss (31%), and intolerance (18.1%). All of the procedures were completed laparoscopically as one-stage procedure. R-RYGB had significantly longer operative times than R-SAGB. Major complication occurred in 12 (10%) patients without significant difference between R-SAGB group and R-RYGB group. At 1 year follow-up, weight loss was better in R-SAGB than R-RYGB (76.8 vs. 32.9% EWL; p = 0.001). At 5 year follow-up, a significantly lower hemoglobin level was found in R-SAGB group (p = 0.03).

Conclusion

Both SAGB and RYGB are acceptable options for revising a restrictive type of bariatric procedures with equal safety profile. R-SAGB was shown to be a simpler procedure with better weight reduction than R-RYGB but anemia is a considerable complication at long-term follow-up.
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Metadata
Title
Revisional Gastric Bypass for Failed Restrictive Procedures: Comparison of Single-Anastomosis (Mini-) and Roux-en-Y Gastric Bypass
Authors
Owaid M. Almalki
Wei-Jei Lee
Jung-Chien Chen
Kong-Han Ser
Yi-Chih Lee
Shu-Chun Chen
Publication date
01-04-2018
Publisher
Springer US
Published in
Obesity Surgery / Issue 4/2018
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-017-2991-0

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