Laparoscopic Wedge Resection of Gastrojejunostomy for Weight Recidivism after Gastric Bypass.

Abstract

Weight recidivism after Roux-en-Y gastric bypass (RYGB) is a common problem. Often, this weight loss failure or regain may be due to a wide gastrojejunostomy (GJ). We evaluated the feasibility and safety of a novel approach of laparoscopic wedge resection of gastrojejunostomy (LWGJ) for a wide stoma after RYGB associated with weight recidivism. This is a single-center retrospective study of a prospectively collected database. We analyzed outcomes of patients with weight recidivism after RYGB and a documented wide GJ (>2cm) on imaging, who underwent LWGJ between 11/2013 and 05/2016. Nine patients underwent LWGJ for dilated stomas. All patients were female with a mean±SD age of 53±7years. Mean interval between RYGB and LWGJ was 9±3years. All cases were performed laparoscopically with no conversions. Mean operative time and hospital stay were 86±9min and 1.2±0.4days, respectively. The median(IQR) follow-up time was 14(12-18) months. During follow-up, there were no deaths, postoperative complications, or unplanned readmissions or reoperations. The mean and median(IQR) BMI before RYGB and LWGJ were 55.4±8.1kg/m2 and 56.1(47.9-61.7) and 43.4±8.6kg/m2 and 42.1(38.3-47.1), respectively. One year after LWGJ, mean and median(IQR) BMI significantly decreased to 34.9±7.3kg/m2 and 33.3(31.7-35.0) corresponding to a mean %EWL of 64.6±19.9 (P<0.05). LWGJ is safe and can lead to further weight loss in patients experiencing weight recidivism after RYGB with a wide GJ (>2cm). Long-term follow-up is needed to determine the efficacy and durability of LWGJ and compare its outcomes with other endoscopic/surgical approaches for weight recidivism after RYGB with a documented wide GJ.