A Step-by-Step Surgical Technique Video of Revision of Roux-en-Y Gastric Bypass with Limb Distalization
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MULTIMEDIA ARTICLE
A Step-by-Step Surgical Technique Video of Revision of Roux-en-Y Gastric Bypass with Limb Distalization Amit Surve 1 & Daniel Cottam 1 Received: 29 July 2020 / Revised: 31 August 2020 / Accepted: 4 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The Roux-en-Y gastric bypass (RYGB) is the second most common bariatric procedure in the USA. Although the RYGB is an effective procedure, some patients will not achieve optimal weight loss or will experience significant weight regain. In this video report, we present a step-by-step surgical technique of RYGB limb distalization in a 49-year-old female patient for inadequate weight loss. Keywords Revision Roux-en-Y gastric bypass . RYGB . Limb distalization . Inadequate weight loss . Surgical technique
Introduction
Purpose
Around 25–30% of the patients with Roux-en-Y gastric bypass (RYGB) will eventually fail the surgery [1, 2]. Failure may be caused by complications related to or unrelated to anastomoses or inadequate weight loss or significant weight regain [1–3]. The reported incidence of anastomotic complications after RYGB ranges from .1 to 23% [4]. The patients that fail the RYGB procedure can be reversed or converted to other bariatric procedures like the traditional Roux-en-Y duodenal switch (DS), single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S), or distal bypass depending on the cause of failure [2, 5–9]. However, 350 cm of total absorptive bowel length needs to be maintained to avoid malnutrition [9].
The study aimed to present our surgical technique of RYGB limb distalization for inadequate weight loss.
Materials and Methods This is a case of a 49-year-old female patient with a body mass index (BMI) of 43.3 kg/m2. The patient had undergone RYGB procedure in the past and presented to us with inadequate weight loss.
Surgical Technique
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04964-9) contains supplementary material, which is available to authorized users. * Daniel Cottam [email protected] Amit Surve [email protected] 1
Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT 84102, USA
A step-by-step surgical technique of RYGB limb distalization is shown in the video. The patient had a Roux limb of 100 cm and a common channel of 1000 cm (Table 1). The length of the biliopancreatic limb (BP) limb was unknown. During the RYGB distalization procedure, the length of the common channel was reduced to 250 cm (Table 1). This length was chosen with the input of the patient after a long discussion about complications and bowel limb lengths. The final total length of the BP limb was approximately 800 cm (Table 1). The hand-drawn sketch of the surgical technique is shown in Fig. 1.
OBES SURG Table 1 Summary of the case Limb
RYGB (preoperative)
Aim
RYGB with limb distalization (postoperative)
Roux limb Blind loop Common channel BP limb
100 cm Not applicable 1000 cm Unknown
No change –
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