Abstract
BackgroundLaparoscopic Roux-en-Y gastric bypass (RYGB) has for long been the gold standard technique in bariatric surgery, especially in the Scandinavian countries. In a tertiary hospital setting, we observed an increasing number of patients with postprandial abdominal pain and nausea, often associated with complex hypoglycemia.ObjectivesThe present study aimed to characterize the clinical patterns, patient characteristics, and clinical outcomes after surgical revision of dysfunctional RYGB at Sahlgrenska University Hospital in Gothenburg, Sweden.MethodsThis cohort study included patients with RYGB who underwent revision of the jejunojejunostomy (JJ) after 2013. Information was obtained by reviewing medical records and performing complementary interviews.ResultsLaparoscopic revisional surgery was performed in 115 cases with either adhesiolysis or total revision of the JJ (mean age 41 years, range 19–67 years; 90% women). The median time to assessment after the last revision was 33 months (range 12–75 months). Forty-four (38%) patients reported that they were symptom-free long-term after the intervention, and 32 (28%) patients experienced an improvement in the symptoms that were the indication for revision. However, 31 (27%) patients reported no long-term improvement, and half of them (n = 16) subsequently had a reversal of the anatomy. Eight (7%) patients were lost to follow-up.ConclusionsDysfunction of the JJ appears to be a relatively common cause of postprandial pain and nausea after ante-colic/ante-gastric RYGB. Most patients with symptoms of dysfunction experienced partial or total relief following revisional surgery, but a substantial minority had persistent problems, with one in five eventually undergoing reversal of the anatomy.Graphical
Highlights
Laparoscopic Roux-en-Y gastric bypass (RYGB) has since long been the gold standard in bariatric surgery and in Scandinavia performed according to the Lönroth method for more than two decades [1]
Patients who were excluded due to issues not related to the JJ had reconstruction of the JJ due to reasons other than JJ dysfunction, such as ischemic Roux limb after internal or ventral hernias, and reconstruction of the gastrojejunostomy followed by JJ reconstruction to avoid having too short of a Roux limb
At the time of primary RYGB are shown in Table 1 and compared to the baseline characteristics of participants in the national register for bariatric surgery (SOReg) from 2013–2017
Summary
Laparoscopic Roux-en-Y gastric bypass (RYGB) has since long been the gold standard in bariatric surgery and in Scandinavia performed according to the Lönroth method for more than two decades [1]. Laparoscopic Roux-en-Y gastric bypass (RYGB) has for long been the gold standard technique in bariatric surgery, especially in the Scandinavian countries. Results Laparoscopic revisional surgery was performed in 115 cases with either adhesiolysis or total revision of the JJ (mean age 41 years, range 19–67 years; 90% women). 31 (27%) patients reported no long-term improvement, and half of them (n = 16) subsequently had a reversal of the anatomy. Most patients with symptoms of dysfunction experienced partial or total relief following revisional surgery, but a substantial minority had persistent problems, with one in five eventually undergoing reversal of the anatomy
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