Abstract
Background
After Roux-en-Y gastric bypass (RYGB), up to 30% failures in weight loss have been reported. Among multiple solutions available, we report our experience with shortening of the common channel (SCC) by performing a limb distalization of the alimentary or the biliopancreatic limb.
Settings
University Hospital.
Methods
We reviewed data from 23 patients that underwent limb distalization between 2001 and 2019 due to inadequate weight loss after an initial RYGB in our center. All patients who failed to achieve an excess weight loss reduction of > 50% or maintained a body mass index (BMI) above 35 kg/m2 were included. Multiple variables were analyzed during the follow-up at five time points: initial, after RYGB, before SCC, after SCC, and current.
Results
The mean BMI prior to the RYGB was 51.8 kg/m2, after RYGB was 37.6 kg/m2, before SCC was 43.6 kg/m2, after SCC was 36.1 kg/m2, and the final BMI was 36.3 kg/m2. No morbidity was seen after SCC. Long-term associated nutritional deficiencies were only identified in 3 patients which had iron deficiency and 1 patient with vitamin D deficiency. Patients with associated comorbidities significantly improved or were withdrawn from medications after the RYGB, with minor variations after SCC.
Conclusions
Limb distalization with SCC is a safe and effective technique for patients who failed to achieve an adequate weight loss after RYGB. There is a slight increase in excess of weight loss after the SCC compared with RYGB. In addition, no further weight regain was documented.
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Abbreviations
- AL:
-
Alimentary limb
- BMI:
-
Body mass index
- BPL:
-
Biliopancreatic limb
- CC:
-
Common channel
- CDC:
-
Clavien-Dindo classification
- CPAP:
-
Continuous positive airway pressure
- DLP:
-
Dyslipidemia
- HT:
-
Arterial hypertension
- OSA:
-
Obstructive sleep apnea
- RYGB:
-
Roux-en-Y gastric bypass
- SCC:
-
Shortening of the common channel
- TD2:
-
Type 2 diabetes
- VI:
-
Venous insufficiency
- %EBMIL:
-
Percentage of excess body mass index loss
- %EWL:
-
Percentage of excess weight loss
References
Bessler M, Daud A, DiGiorgi MF, et al. Adjustable gastric banding as a revisional bariatric procedure after failed gastric bypass. Obes Surg. 2005;15(10):1443–8.
Philip W, James T. Obesity-a modern pandemic: the burden of disease. Endocrinol Nutr. 2013;60(1):3–6.
Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes - 5-year outcomes. N Engl J Med. 2017;376(7):641–51.
Switzer NJ, Karmali S, Gill RS, et al. Revisional bariatric surgery. Surg Clin North Am. 2016;96(4):827–42.
Salminen P, Helmio M, Ovaska J, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic roux-en-y gastric bypass on weight loss at 5 years among patients with morbid obesity the SLEEVEPASS randomized clinical trial. JAMA. 2018;319(3):241–54.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. J Am Med Assoc. 2004;292(14):1724–37.
Patel S, Szomstein S, Rosenthal RJ. Reasons and outcomes of reoperative bariatric surgery for failed and complicated procedures (excluding adjustable gastric banding). Obes Surg. 2011;21(8):1209–19.
Elnahas AI, Jackson TD, Hong D. Management of failed laparoscopic roux-en-Y gastric bypass. Bariatr Surg Pract Patient Care. 2014;9(1):36–40.
Shin RD, Goldberg MB, Shafran AS, et al. Revision of Roux-en-Y gastric bypass with limb distalization for inadequate weight loss or weight regain. Obes Surg. 2019;29(3):811–8.
Ortega J, Cassinello N, Sánchez-Antúnez D, et al. Anatomical basis for the low incidence of internal hernia after a laparoscopic Roux-en-Y gastric bypass without mesenteric closure. Obes Surg. 2013;23(8):1273–80.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.
American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2013;36(Suppl 1):S11–6.
Rogers A et al. ASMBS clinical issues committee. Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis. 2015;11:489–506.
Dapri G, Cadière GB, Himpens J. Laparoscopic conversion of Roux-en-Y gastric bypass to distal gastric bypass for weight regain. J Laparoendosc Adv Surg Tech. 2011;21(1):19–23.
Ghiassi S, Higa K, Chang S, et al. Conversion of standard Roux-en-Y gastric bypass to distal bypass for weight loss failure and metabolic syndrome: 3-year follow-up and evolution of technique to reduce nutritional complications. Surg Obes Relat Dis. 2018;14(5):554–61.
Rawlins ML, Teel D, Hedgcorth K, et al. Revision of Roux-en-Y gastric bypass to distal bypass for failed weight loss. Surg Obes Relat Dis. 2011;7(1):45–9.
Sugerman HJ, Kellum JM, DeMaria EJ. Conversion of proximal to distal gastric bypass for failed gastric bypass for superobesity. J Gastrointest Surg. 1997;1(6):517–24.
Fobi MAL, Lee H, Igwe D, et al. Revision of failed gastric bypass to distal Roux-en-Y gastric bypass: a review of 65 cases. Obes Surg. 2001;11(2):190–5.
Odstrcil EA, Martinez JG, Santa Ana CA, et al. The contribution of malabsorption to the reduction in net energy absorption after long-limb Roux-en-Y gastric bypass. Am J Clin Nutr. 2010;92(4):704–13.
Hernández-Martínez J, Calvo-Ros MÁ. Gastric by-pass with fixed 230-cm-long common limb and variable alimentary and biliopancreatic limbs in morbid obesity. Obes Surg. 2011;21(12):1879–86.
Mahawar KK, Kumar P, Parmar C, et al. Small bowel limb lengths and Roux-en-Y gastric bypass: a systematic review. Obes Surg. 2016;26(3):660–71.
Sethi M, Chau E, Youn A, et al. Long-term outcomes after biliopancreatic diversion with and without duodenal switch: 2-, 5-, and 10-year data. Surg Obes Relat Dis. 2016;12(9):1697–705.
Caruana JA, Monte SV, Jacobs DM, et al. Distal small bowel bypass for weight regain after gastric bypass: safety and efficacy threshold occurs at<70% bypass. Surg Obes Relat Dis. 2015;11(6):1248–55.
Zhang L, Tan WH, Chang R, et al. Perioperative risk and complications of revisional bariatric surgery compared to primary Roux-en-Y gastric bypass. Surg Endosc. 2015;29(6):1316–20.
Brolin RE, Cody RP. Adding malabsorption for weight loss failure after gastric bypass. Surg Endosc Other Interv Tech. 2007;21(11):1924–6.
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.
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Ortega-Serrano, J., Kraus-Fischer, G., Alfonso-Ballester, R. et al. Shortening of the Common Channel as a Rescue Surgery After Gastric Bypass Failure. OBES SURG 30, 4760–4767 (2020). https://doi.org/10.1007/s11695-020-04854-0
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DOI: https://doi.org/10.1007/s11695-020-04854-0