Midterm Outcomes of Gastric Pouch Resizing for Weight Regain After Roux-en-Y Gastric Bypass
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ORIGINAL CONTRIBUTIONS
Midterm Outcomes of Gastric Pouch Resizing for Weight Regain After Roux-en-Y Gastric Bypass Imed Ben Amor 1 & Niccolo Petrucciani 2 & Radwan Kassir 3 & Eugene Malyshev 1 & Clementine Mazoyer 1 & Carine Korkmaz 1 & Tarek Debs 1 & Jean Gugenheim 1
# Springer Science+Business Media, LLC, part of Springer Nature 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%. Keywords Gastric pouch resizing laparoscopic Roux-en-Y gastric bypass . Weight regain . Excess weight loss . Revision
Introduction Bariatric surgery volume is rising worldwide according to IFSO data and to national database studies [1–3]. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the first procedure that allowed the widespread of bariatric surgery less than 20 years ago, and until 2013, it was the most commonly performed [4]. Its complication profile has decreased
* Niccolo Petrucciani [email protected] 1
Division of Digestive Surgery and Liver Transplantation, Archet 2 Hospital, University Hospital of Nice, Nice, France
2
Department of Medical-Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University, Sant’Andrea Hospital, via di Grottarossa 1035-9, 00139 Rome, Italy
3
Department of Digestive Surgery, CHU Félix Guyon, La réunion, Saint Denis, France
substantially over the years, and its efficacy on improving obesity-related comorbidities has been well demonstrated [5–8]; however, 20–35% of patients regain weight on the long term or fail to lose it in the first place [9–12]. Weight regain may be related to multiple factors,
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