Revisional Laparoscopic Mini-Gastric Bypass as a Treatment Option for Weight Loss Failure after Restrictive Procedures

Abstract

Background: Bariatric surgery has proven its effectiveness in achieving and maintaining weight loss and improving obesity-related co-morbidities, quality of life, and survival. As demand for bariatric surgery increases, so too will the need for revisional surgeries. The revision rate following primary bariatric surgery is reported to be between 10% and 25%. To facilitate weight loss surgically, many different types of bariatric procedures have been developed and established. Objectives: To assess the effectiveness of revisional laparoscopic mini-gastric bypass for management of inadequate weight loss after different restrictive procedures. Patients and methods: The present study is a prospective study that was conducted at Ain Shams University Hospitals in Egypt, between July 2016 and July 2018. It included Forty (40) patients who underwent a restrictive bariatric procedure 2 years ago or more with inadequate weight loss. Operative time, intraoperative complications, rate of conversion. Postoperative pain, consumption of analgesics, length of hospital stay, start of oral feeding were noted. Results: The patients series involved 40 patients, 12 of which were male patients (40%) whereas, 24 were female patients (60%). The patients’ age at the time of revisional surgery ranged from 23 to 57 years old with a mean ± SD of 38.50 ± 8.42 years. The preoperative BMI ranged from 31.25 to 52.62 kg/m2 with a mean ± SD of 41.59 ± 4.99 kg/m2 with an excess weight ranging from 19.79 to 86 kg with a mean ± SD of 46.51 ± 14.27 kg. The mean time interval between the initial restrictive surgery and the revisional LMGB was 41.63 ± 16.92 months. 18 patients (45%) had a VBG as their primary restrictive surgery, 10 patients (25%) had LAGB, 8 patients (20%) had LSG and 4 patients (10%) had LGCP. 28 patients (70%) underwent LMGB for IWL compared to 12 patients (30%) for WR. Conclusion: The revisional Laparoscopic Mini-Gastric Bypass (r-LMGB) appears to be a feasible and safe option after failed restrictive bariatric surgery. However, additional studies with larger population and longer follow up period are required to evaluate longer-term success.