Sa1944 REPEAT TRANSORAL OUTLET REDUCTION (TORE) FOR PATIENTS WITH WEIGHT REGAIN FOLLOWING ROUX-EN-Y GASTRIC BYPASS (RYGB)

Abstract

Transoral outlet reduction (TORe) is a minimally invasive therapeutic option to revise a dilated gastrojejunal anastomosis in patients with weight regain following Roux-en-Y gastric bypass (RYGB), with up to 9% sustained total body weight loss (TWL). Yet, some patients do not respond as expected or quickly regain the lost weight. Our aim is to evaluate the efficacy of repeating TORe in these patients. This is a retrospective review of prospectively collected data, for all the patients who underwent TORe with Apollo overstitch from 2010 to 2018 at our center. Patient who had repeat TORe were included in the analysis. Patients who had the outlet reduction with older devices or plication systems were not included. Demographics, weight data and procedural details were abstracted from the chart. %TWL was compared at 1 year post operatively and at the end of the follow-up using t and chi square tests when appropriate. We identified 321 patients that had at least one TORe procedure. Among them, 23 patients (7%) were offered repeated TORe and were included in the analysis. Average age was 49 (+/-10) years, 83% females, and a total follow-up time of 5 (+/-2) years. Two groups of patients were considered for repeat TORe, non-responders, defined as those who were unable to achieve 5% TWL at 12 months following the first TORe (11 patients). The second group are the responders, who regained weight after initial adequate (=>5%) weight loss (12 patients). At one-year post index TORe, patients who were classified as responders lost an average of - 28 Ibs (+/- 14 Ibs, TWL of -11%, p<0.001). As compared to those who were classified as non-responders who lost -4 Ibs (+/-7 Ibs, TWL of +3%, p =0.14). Both groups underwent repeat TORe (within an average of 3.5 years and 2.3 years for responders and non-responders respectively from the index TORe). At one year post repeat TORe, responders successfully lost an average of - 27 Ibs (+/-21 Ibs, TWL of -11%, p<0.001). As compared non-responders who gained an average of 5 Ibs (+/- 14 Ibs, TWL of -3%, p =0.32). Both groups were followed-up for an average of 2.3 years following the repeat TORe. Responders had sustained TWL of -10% (p=0.002) whereas non-responders had a TWL of -4% (0.13) as compared to the weight prior to the repeat TORe procedure, Figure 1. Non-responders had lower average BMI prior to the index TORe (34 versus 41, p=0.02) and more likely to have had interrupted suture pattern during the index TORe (45% versus 17%, p=0.13), Table 1. Repeating TORe procedure is a reasonable option for those who had weight regain following initial adequate response to the index TORe. On the other hand, those who did not respond to the index TORe should be considered for alternative options such as anti-obesity medications or surgical revision.View Large Image Figure ViewerDownload Hi-res image Download (PPT)