Top

Published in:

01-07-2020 | Original Contributions

Midterm Outcomes of Gastric Pouch Resizing for Weight Regain After Roux-en-Y Gastric Bypass

Authors: Imed Ben Amor, Niccolo Petrucciani, Radwan Kassir, Eugene Malyshev, Clementine Mazoyer, Carine Korkmaz, Tarek Debs, Jean Gugenheim

Published in: Obesity Surgery | Issue 7/2020

Abstract

Purpose

Resizing of the gastric pouch, with eventually resizing of the gastrojejunal anastomosis, has been proposed as revisional procedure to treat weight regain after Roux-en-Y gastric bypass (RYGB), in patients with large gastric pouch and/or large gastrojejunal (GJ) anastomosis. The aim of this study is to determine the midterm results and the safety of laparoscopic resizing of the gastric pouch after RYGB in cases where gastric pouch is > 200 ml and/or GJ anastomosis > 20 mm.

Materials and Methods

All patients who underwent gastric pouch resizing between January 2009 and December 2016 were retrospectively reviewed from a prospective database. The gastric pouch was resized to a volume of 30–40 ml.

Results

A total of 48 patients had gastric pouch resizing after RYGB. The mean initial BMI was 42.9 ± 4.8 kg/m². Perioperative morbidity was 8.3% in this series. Mean follow-up was 5.4 years. The mean BMI was 30.0 ± 7.3 kg/m² at 1 year, 30.0 ± 6.0 kg/m² at 3 years, and 30.9 ± 5.7 kg/m² at 5 years. Mean %EBMIL at 1-, 3-, and 5-year follow-up was 51.9%, 55.1%, and 39%, respectively, in 48% follow-up rate. The obesity-related comorbidities disappeared in 67.3% of cases at maximum follow-up.

Conclusions

In carefully selected patients with gastric pouch size > 200 ml and/or GJ anastomosis > 20 mm, and after extensive preoperative evaluation, gastric pouch resizing is a potentially effective option to treat weight regain due to anatomical factors after RYGB, with complication rate of 8%.

Welbourn R, Pournaras DJ, Dixon J, et al. Bariatric surgery worldwide: baseline demographic description and one-year outcomes from the Second IFSO Global Registry Report 2013-2015. Obes Surg. 2018;28(2):313–22. https://doi.org/10.1007/s11695-017-2845-9.CrossRefPubMed

Debs T, Petrucciani N, Kassir R, et al. Trends of bariatric surgery in France during the last 10 years: analysis of 267,466 procedures from 2005–2014. Surg Obes Relat Dis. 2016;12(8):1602–9. https://doi.org/10.1016/j.soard.2016.05.010.CrossRefPubMed

Thereaux J, Lesuffleur T, Païta M, et al. Long-term follow-up after bariatric surgery in a national cohort. Br J Surg. 2017;104(10):1362–71. https://doi.org/10.1002/bjs.10557.CrossRefPubMed

Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obes Surg. 2017; https://doi.org/10.1007/s11695-017-2666-x. Erratum in: Obes Surg. 2017 Jul 5.

Osland E, Yunus RM, Khan S, et al. Diabetes improvement and resolution following laparoscopic vertical sleeve gastrectomy (LVSG) versus laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures: a systematic review of randomized controlled trials. Surg Endosc. 2017;31(4):1952–63. https://doi.org/10.1007/s00464-016-5202-5.CrossRefPubMed

Chakravartty S, Tassinari D, Salerno A, et al. What is the mechanism behind weight loss maintenance with gastric bypass? Curr Obes Rep. 2015;4(2):262–8. https://doi.org/10.1007/s13679-015-0158-7.CrossRefPubMed

Coblijn UK, Verveld CJ, van Wagensveld BA, et al. Laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy as revisional procedure after adjustable gastric band--a systematic review. Obes Surg. 2013;23(11):1899–914. https://doi.org/10.1007/s11695-013-1058-0.CrossRefPubMed

Lager CJ, Esfandiari NH, Subauste AR, et al. Milestone weight loss goals (weight normalization and remission of obesity) after gastric bypass surgery: long-term results from the University of Michigan. Obes Surg. 2017;27(7):1659–66. https://doi.org/10.1007/s11695-016-2533-1.CrossRefPubMedPubMedCentral

Pories WJ, Macdonald Jr KG, Morgan EJ, et al. Surgical treatment of obesity and its effect on diabetes: 10-yr follow-up. Am J Clin Nutr. 1992;55:582S–5S.CrossRef

10.

Christou NV, Look D, MacLean LD. Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg. 2006;244(5):734–40.CrossRef

11.

Buchwald H. Revisional metabolic/bariatric surgery: a moral obligation. Obes Surg. 2015;25(3):547–9.CrossRef

12.

Buchwald H, Oien DM. Revision Roux-en-Y gastric bypass to biliopancreatic long-limb gastric bypass for inadequate weight response: case series and analysis. Obes Surg. 2017;27:2293–302. https://doi.org/10.1007/s11695-017-2658-x.CrossRef

13.

Maleckas A, Gudaitytė R, Petereit R, et al. Weight regain after gastric bypass: etiology and treatment options. Gland Surg. 2016;5(6):617–24. https://doi.org/10.21037/gs.2016.12.02.CrossRefPubMedPubMedCentral

14.

da Silva FB, Gomes DL, de Carvalho KM. Poor diet quality and postoperative time are independent risk factors for weight regain after Roux-en-Y gastric bypass. Nutrition. 2016;32(11–12):1250–3. https://doi.org/10.1016/j.nut.2016.01.018.CrossRefPubMed

15.

Thompson CC, Slattery J, Bundga ME, et al. Peroral endoscopic reduction of dilated gastrojejunal anastomosis after Roux-en-Y gastric bypass: a possible new option for patients with weight regain. Surg Endosc. 2006;20(11):1744–8.CrossRef

16.

Borbély Y, Winkler C, Kröll D, et al. Pouch reshaping for significant weight regain after Roux-en-Y gastric bypass. Obes Surg. 2017;27(2):439–44. https://doi.org/10.1007/s11695-016-2329-3.CrossRefPubMed

17.

Al-Bader I, Khoursheed M, Al Sharaf K, et al. Revisional laparoscopic gastric pouch resizing for inadequate weight loss after Roux-en-Y gastric bypass. Obes Surg. 2015;25(7):1103–8. https://doi.org/10.1007/s11695-015-1579-9. Erratum in: Obes Surg. 2015 Jul;25(7):1109.CrossRefPubMedPubMedCentral

18.

Müller MK, Wildi S, Scholz T, et al. Laparoscopic pouch resizing and redo of gastro-jejunal anastomosis for pouch dilatation following gastric bypass. Obes Surg. 2005;15(8):1089–95.CrossRef

19.

Iannelli A, Schneck AS, Hébuterne X, et al. Gastric pouch resizing for Roux-en-Y gastric bypass failure in patients with a dilated pouch. Surg Obes Relat Dis. 2013;9(2):260–7. https://doi.org/10.1016/j.soard.2012.05.003.CrossRefPubMed

20.

Amor IB, Debs T, Petrucciani N, et al. A simple technique of gastric pouch resizing for inadequate weight loss after Roux-en-Y gastric bypass. Obes Surg. 2017;27(1):273–4. https://doi.org/10.1007/s11695-016-2424-5.CrossRefPubMed

21.

Hamdi A, Julien C, Brown P, et al. Midterm outcomes of revisional surgery for gastric pouch and gastrojejunal anastomotic enlargement in patients with weight regain after gastric bypass for morbid obesity. Obes Surg. 2014;24(8):1386–90. https://doi.org/10.1007/s11695-014-1216-z.CrossRefPubMed

22.

Kassir R, Lointier P, Tiffet O, et al. Revision bariatric surgery: what technical choices should be taken depending on the first intervention? Int J Surg. 2017;44:7–8. https://doi.org/10.1016/j.ijsu.2017.05.075.CrossRefPubMed

23.

Tran DD, Nwokeabia ID, Purnell S, et al. Revision of Roux-en-Y gastric bypass for weight regain: a systematic review of techniques and outcomes. Obes Surg. 2016;26(7):1627–34. https://doi.org/10.1007/s11695-016-2201-5.CrossRef

24.

Nguyen D, Dip F, Huaco JA, et al. Outcomes of revisional treatment modalities in non-complicated Roux-en-Y gastric bypass patients with weight regain. Obes Surg. 2015;25(5):928–34. https://doi.org/10.1007/s11695-015-1615-9.CrossRef

25.

Blanchet MC, Mesmann C, Yanes M, et al. 3D gastric computed tomography as a new imaging in patients with failure or complication after bariatric surgery. Obes Surg. 2010;20(12):1727–33. https://doi.org/10.1007/s11695-010-0256-2.CrossRefPubMed

26.

Alva S, Eisenberg D, Duffy A, et al. Virtual three-dimensional computed tomography assessment of the gastric pouch following laparoscopic Roux-Y gastric bypass. Obes Surg. 2008;18(4):364–6. https://doi.org/10.1007/s11695-008-9438-6.CrossRefPubMed

27.

Parikh M, Heacock L, Gagner M. Laparoscopic "gastrojejunal sleeve reduction" as a revision procedure for weight loss failure after Roux-en-Y gastric bypass. Obes Surg. 2011;21(5):650–4. https://doi.org/10.1007/s11695-010-0274-0.CrossRefPubMed

Title: Midterm Outcomes of Gastric Pouch Resizing for Weight Regain After Roux-en-Y Gastric Bypass
Authors: Imed Ben Amor
Niccolo Petrucciani
Radwan Kassir
Eugene Malyshev
Clementine Mazoyer
Carine Korkmaz
Tarek Debs
Jean Gugenheim
Publication date: 01-07-2020
Publisher: Springer US
Published in: Obesity Surgery / Issue 7/2020
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-020-04560-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Midterm Outcomes of Gastric Pouch Resizing for Weight Regain After Roux-en-Y Gastric Bypass

Abstract

Purpose

Materials and Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Materials and Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2020

Performance of Noninvasive Liver Fibrosis Scores in the Morbid Obese Patient, Same Scores but Different Thresholds

Correction to: Real Life Changes in Physical Activity due to Intragastric Balloon Therapy and their Relationship to Improving Cognitive Functions: Preliminary Findings

Real Life Changes in Physical Activity Due to Intragastric Balloon Therapy and Their Relationship to Improving Cognitive Functions: Preliminary Findings

Long-Term Evaluation of Biliary Reflux on Esogastric Mucosae after One-Anastomosis Gastric Bypass and Esojejunostomy in Rats

Mechanism of Bile Acid Reabsorption in the Biliopancreatic Limb After Duodenal-Jejunal Bypass in Rats

High Risk of Hypophosphatemia in Patients with Previous Bariatric Surgery Receiving Ferric Carboxymaltose: A Prospective Cohort Study