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

Abstract

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 > 200ml and/or GJ anastomosis > 20mm. 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 30-40ml. A total of 48 patients had gastric pouch resizing after RYGB. The mean initial BMI was 42.9 ± 4.8kg/m2. Perioperative morbidity was 8.3% in this series. Mean follow-up was 5.4years. The mean BMI was 30.0 ± 7.3kg/m2 at 1year, 30.0 ± 6.0kg/m2 at 3years, and 30.9 ± 5.7kg/m2 at 5years. 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. In carefully selected patients with gastric pouch size > 200ml and/or GJ anastomosis > 20mm, 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%.