Distal Gastric Bypass Research Articles

Does the length of bypassed bowel during distal gastric bypass affect weight loss?

Weight recurrence (WR) affects > 20% of patients following Roux-en-Y gastric bypass (RYGB). Shortening of the common channel (CC) after RYGB (distal bypass) has been proposed for additional weight loss in patients with WR, but results vary, and concerns for vitamin deficiencies/malnutrition exist. Our aim was to determine whether the percentage of bowel bypassed after distal bypass is associated with the amount of postoperative weight loss. Patients undergoing distal bypass between 2018 and 2022 were reviewed. Small bowel limb lengths before and after distal bypass were measured, and the percentage of bypassed bowel was calculated (= bypassed biliopancreatic limb/total small bowel length). Patients were dichotomized into two groups based on the percentage bypassed bowel (≤ 50% vs. > 50%). Weight loss (measured as excess BMI loss; EBIL%), comorbidities resolution, complications, and nutritional deficiencies were reviewed. Thirty female patients underwent distal bypass during the study period. After distal bypass, the Roux was lengthened to 150cm (75-175cm) from 75cm (20-200cm), and the CC shortened to 150cm (100-310cm) from 510cm (250-1000cm). These changes resulted in an increase in the size of the bypassed biliopancreatic limb from 40cm (15-90cm) to 330cm (180-765cm) and a total alimentary limb (TALL; Roux + CC) shortening from 590cm (400-1075cm) to 300cm (250-400cm). The group with > 50% bowel bypassed had higher EBIL%. Overall EBIL% was 36.9 ± 14.7%, 53.3 ± 25.6%, and 62.1 ± 36.9% at 0.5, 1, and 2years, respectively. There were minimal vitamin deficiencies. Diabetes resolved in 100% (n = 3/3), HTN in 67% (n = 10/15), and GERD in 73% (n = 11/15). Complication rate was 23%. No reintervention for malnutrition or vitamin deficiencies was required. Distal bypass effectively leads to considerable weight loss and comorbidity improvement in patients with WR after RYGB, but the amount of weight loss depends on the percentage of bypassed bowel. An exact threshold of bypassed bowel that optimizes weight loss outcomes and simultaneously minimizes the nutritional complications needs to be determined. Meanwhile, close monitoring for vitamin deficiencies is recommended.

Laparoscopic gastric bypass surgery with a single anastomosis: a comparative analysis of the metabolic and bariatric effects

Objective. To compare the results of the effect of long–loop, distal and mini–gastric bypass surgery with a single anastomosis on the loss of excess body weight, indicators of protein, lipid, carbohydrate metabolism, correction of metabolic syndrome and development of deficiency states after 36 months. Materials and methods. Patients with morbid obesity were divided into 3 groups: Group 1 – 25 patients who underwent long–loop gastric bypass with a biliopancreatic loop length of 200 cm; Group 2 – 25 patients who underwent mini–gastric bypass with a biliopancreatic loop length of 200 cm using laparoscopic access; Group 3 – 25 patients who underwent distal gastric bypass with a total loop length of 250 cm. Results. 36 months after the operation, the loss of excess body weight was (69 ± 1.1)% in group 1, (70.1 ± 1.3)% in group 2 and (72 ± 0.9)% in group 3; remission of dyslipidaemia was observed in 4 (80%) of 5 patients in group 1, 11 (84.6%) of 13 patients in group 2 and 7 (100%) of 7 patients in group 3; remission of type II diabetes mellitus – in 3 (75%) out of 4, 5 (83.3%) out of 6 and 6 (100%) out of 6 patients, respectively, complete remission of arterial hypertension – in 6 (46.2%) out of 13, 7 (50%) out of 14 and 9 (60%) out of 15 patients, respectively. Conclusions. Laparoscopic long–loop gastric bypass with a single anastomosis is effective and safe, does not cause severe deficiency states, and can be used as a primary bariatric surgery.

Long-term weight loss of distal gastric bypass is moderately superior compared to proximal gastric bypass in patients with a BMI of 37-44 Kg/m2.

The laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the standard procedures in metabolic surgery. Different limb lengths have been proposed in the past to maximize weight loss (WL) and reduce metabolic complications. Distal gastric bypass surgery with a very short common channel (CC) (up to 100cm) has been often criticized due to frequent side effects such as malnutrition, bone weakening and short-bowel syndrome. We introduced a modified version of a distal LRYGB with a 50-70cm long biliopancreatic limb (BPL) and an intermediate short CC (120-150cm). Our primary goal was to compare the long-term WL between distal and proximal LRYGB in two cohorts of patients. Secondary outcomes were weight regain (WR), insufficient weight loss (IWL), postoperative complications and metabolic changes 5 years after surgery. In this retrospective study we collected data from 160 patients operated between 2014 and 2015, with a BMI of 37-44 Kg/m2. 101 patients underwent a distal and 59 patients a proximal LRYGB in two bariatric centers. WL was calculated as percent of excess of BMI loss (%EBMIL), loss of body mass index (Delta-BMI), percent of excess weight loss (%EWL) and percent of total weight loss (%TWL). Data were collected 3, 6, 9, 12, 24, 48 and 60 months after surgery. The distal LRYGB resulted in significantly better 5-year-WL compared to the proximal bypass in terms of %EBMIL (median at 5 years: 83% vs. 65%, p = 0.001), %TWL (median at 5 years: 32% vs. 26%, p = 0.017) and %EWL (median at 5 years: 65% vs. 51%, p = 0.029), with equal major complications and metabolic alterations. In addition, WR was significantly lower in patients with distal bypass (18% vs. 35%, p = 0.032). Distal LYRGB with a 120-150 long CC results in better WL and WL-maintenance compared to proximal LRYGB without major side effects after five years.

A060 Laparoscopic Conversion of Gastric Bypass to Distal Gastric Bypass for Inadequate Weight Loss

A060 Laparoscopic Conversion of Gastric Bypass to Distal Gastric Bypass for Inadequate Weight Loss

Distal gastric bypass revision for weight recurrence or nonresponse to primary procedure: initial experience and outcomes in an academic practice.

Considerable weight recurrence (WR) after Roux-en-Y gastric bypass (RYGB) may occur in nearly 20% of patients. While several nonoperative, endoscopic, and surgical interventions exist for this population, the optimal approach is unknown. This study reports our initial experience with distal bypass revision (DGB) and provides a comparison with patients after primary RYGB. Single-institution, retrospective review was conducted for patients who underwent DGB from 2018 to 2020. A Roux and common channel of 150cm each were constructed (total alimentary limb 300cm). A group of primary RYGB patients with similar demographics were selected as controls. Demographics, comorbidity resolution, surgical technique, complications, excess weight loss (EWL), total weight loss (TWL), BMI, and weight change data were compared. Patient postoperative weight loss (WL) was also compared after their primary and DGB operations. Sixteen DGB patients, all female, were compared with 29 controls. DGB was performed on average 12.3years after primary RYGB. In the DGB group, mean BMI was 53.7 before primary RYGB, 31.9 at nadir, and 44.1 prior to DGB. Post-DGB, mean BMI was 40.5, 37.4, 34.8, and 34.4, at 3-, 6-, 12-, and 24-months, respectively. Five patients (31.3%) experienced complications and were readmitted within 30days, with two of them (12.5%) requiring reintervention and one (6.3%) undergoing reoperation. Mean EWL and TWL up to 2years after DGB were lower than that after the patient's original RYGB (52.3 ± 18.6 vs. 67.2 ± 33.2; p = 0.126 and 19.6 ± 13.3 vs. 29.6 ± 11.8; p = 0.027, respectively). DGB resulted in excellent WL up to 2years after surgery but was associated with considerable postoperative complication rates. The magnitude of TWL was lower compared with the primary operation. Only a few patients experienced nutritional complications. Results of this study can help counsel patients pursuing DGB for WR or nonresponse to primary RYGB. The comparative effectiveness of this approach to other available options remains to be determined.

Revision of Roux-en-Y Gastric Bypass for Inadequate Weight Loss or Weight Regain

Inadequate weight loss or weight regain after Roux-en-Y gastric bypass (RYGBP) occurs in more than a quarter of patients for various reasons. Available remedying treatment options include endoscopic and surgical techniques for revision of the gastric pouch and the gastro-jejunal anastomosis, conversion of standard to distal gastric bypass (DRYGBP) or the conversion of RYGBP to biliopancreatic diversion (BPD) or duodenal switch (DS). There is quite a variability concerning the technical simplicity, safety, and effectiveness of these techniques and the small number of patients in the numerous single-center reports precludes any meaningful comparisons. This review aimed to describe all available methods and present the advantages and disadvantages of each of them, to facilitate, rather than guide, the decision of the average bariatric surgeon who encounters such a patient.

Weight loss and malnutrition after conversion of the primary Roux-en-Y gastric bypass to distal gastric bypass in patients with morbid obesity.

After Roux-en-Y gastric bypass (RYGB), 15% to 35% of patients fail to lose sufficient weight. Distalization of the limbs of the RYGB (D-RYGB) with shortening of the common channel (CC), has been used to induce additional weight loss. However, this may increase the risk of malnutrition. The aim of this study was to assess postoperative outcomes after D-RYGB with an alimentary limb of 250 to 300 cm and CC of 100 cm. General hospital, specialized in bariatric surgery. We retrospectively studied all patients who underwent revision of RYGB to D-RYGB between January 2014 and April 2018. Data were collected from medical records, including weight loss, nutritional deficiencies, and co-morbidities. Questionnaires on defecation pattern, quality of life, and patient satisfaction were obtained. Forty-seven patients were included. Total weight loss (%TWL) increased significantly from 12% to 30% after D-RYGB. In 62% of patients %TWL >25% was achieved. Patients with %TWL <25% after primary RYGB, lost significantly more weight than initially reached after RYGB. Diabetes and hypertension remission occurred in 67% and 50%, respectively. Five patients (11%) needed subsequent lengthening of the CC to 250 cm due to protein malnutrition or debilitating defecation patterns. Nutritional deficiencies were present in 89% of patients after D-RYGB despite the prescription of specialized multivitamins. Conversion of the primary RYGB to D-RYGB improves weight loss and co-morbidities in patients with insufficient weight loss after primary RYGB. After D-RYGB, nutritional complications and diarrhea are a risk. Based on this study, a modified D-RYGB with a longer CC of >200 cmwill be considered.

Conventional Versus Distal Laparoscopic One-Anastomosis Gastric Bypass: a Randomized Controlled Trial with 1-Year Follow-up.

There is no consensus on the ideal small bowel length that should be bypassed in laparoscopic one-anastomosis gastric bypass (OAGB). This study aimed to compare the safety and efficacy of conventional versus distal techniques of laparoscopic OAGB. This randomized controlled trial involved 60 adults with morbid obesity scheduled for laparoscopic OAGB randomly assigned to one of the two techniques; conventional technique (fixed anastomosis 200cm from the ligament of Treitz) and distal technique (anastomosis 400cm from the ileocecal valve). Total small bowel length (TSBL) was measured in all cases. Quality of life was assessed using the Gastrointestinal Quality of Life Index (GIQLI). Outcome measures were excess body weight loss percentage (EBWL%), resolution of associated comorbidities, frequency of nutritional deficiencies, and quality of life. No patients were lost to follow-up. The two groups were comparable in TSBL, EBWL%, and complete resolution of comorbidities up to 12months. The percentage of afferent loop length to TSBL was significantly higher in the distal group (p < 0.001) but was not correlated with EBWL%. The levels of hemoglobin, cholesterol, triglycerides, iron, and albumin were significantly lower and parathormone hormone was higher in the distal group. The GIQLI score was significantly higher in the conventional group during follow-up. OAGB achieves optimum results when the afferent loop length is 200cm; bypassing more than 200cm does not improve weight loss or comorbidity resolution. Measuring TSBL is recommended to avoid excessive small bowel shortening that increases the risk of nutritional consequences.

Distal gastric bypass: 2-m biliopancreatic limb construction with varying lengths of common channel

BackgroundLong-term durability after Roux-en-Y gastric bypass is challenging in the super-obese population. Although lengthening of biliopancreatic limb (BPL) is associated with higher rates of weight loss, shortening of common limb (CL) is related to higher risk of malabsorption. ObjectivesIn this study, we aimed at evaluating the importance of the total alimentary limb length by creating a 2-m BPL diversion with varying CL lengths. SettingHigh-volume bariatric center, Norway. MethodsThree groups of patients (N = 187) with different limb lengths were included in this retrospective cohort-analysis as follows: group 1 (n = 69; Roux limb = 150 cm, BPL = 60 cm), group 2 (n = 88; BPL = 200 cm, CL = 150 cm), and group 3 (n = 30; BPL = 200 cm, CL = 200 cm). Weight loss, regain, and failure were analyzed along with malabsorption issues. ResultsPreoperative body mass index (BMI) was higher in group 2 (58.5, P < .001) and 3 (57.4) versus group 1 (54.6, P = .011). No other clinically significant differences between the groups were noted. Follow-up rate was 95% at year 2, 74% at year 5, and 52% at year 10. At 10-year follow-up, excess weight loss and total weight loss was higher in group 2 (70.4%; 40.3%) and 3 (64.0%; 35.9%) compared with group 1 (55.9%; 29.2%). Excess weight loss failure was higher in group 1 versus 2 (30% versus 8.3%, P < .001). No difference in short- or long-term complications was seen except higher occurrence of internal hernia in distal Roux-en-Y gastric bypass groups (11.4%, 6.7%). Vitamin and mineral deficiencies occurred more frequently the shorter the CL was. ConclusionSustainable weight loss in a long-term follow-up is achieved by shortening the total alimentary limb length with a 2-m BPL diversion that should not be attached <200 cm from the ileocecal junction owing to higher rates of internal hernia and vitamin and mineral deficiencies.

Bone Turnover Markers After Standard and Distal Roux-en-Y Gastric Bypass: Results from a Randomized Controlled Trial.

Roux-en-Y gastric bypass is associated with increased risk of bone fractures. Malabsorptive procedures may be associated with secondary hyperparathyroidism and detrimental effects on bone health. We aimed to compare the effects of standard and distal gastric bypass on bone turnover markers 2years after surgery. Patients with body mass index (BMI) 50-60kg/m2 (n = 113) were randomized to standard or distal gastric bypass, 105 patients (95%) completed 2-year follow-up. Serum C-terminal telopeptide of type I collagen (CTX-1), procollagen type I N-propeptide (PINP), and bone-derived alkaline phosphatase (BALP) was measured at baseline and up to 2years after surgery. ANCOVA and linear mixed models were used to compare groups. The levels of bone turnover markers increased significantly in both groups, with no statistically significant difference between groups. Two years after standard and distal gastric bypass mean (SD) CTX-1 were 0.81 (0.32) and 0.83 (0.31) μg/L (p = 0.38), mean PINP was 77.6 (23.2) and 77.7 (29.3) μg/L (p = 0.42), and BALP 47.9 (21.9) vs. 50.7 (19.6) μg/L (p = 0.38), respectively. Multiple linear regression analyses showed that PINP and BALP correlated positively (p = 0.01 and p < 0.001) with PTH, but only BALP was significantly higher in patients with secondary hyperparathyroidism (p = 0.001). Type of surgery, vitamin D serum concentrations, and 2-year BMI were all independently associated with PTH levels. A comparable increase in bone turnover markers 2years after standard and distal gastric bypass was observed. There was a higher prevalence of secondary hyperparathyroidism after distal gastric bypass, but this did not impact bone turnover markers. Clinical Trials.gov number NCT00821197.

A5025 - Bone turnover markers two years after standard and distal gastric bypass a randomized controlled trial

A5025 - Bone turnover markers two years after standard and distal gastric bypass a randomized controlled trial

Patient-Reported Outcome Measures 2\xa0Years After Standard and Distal Gastric Bypass\u2014a Double-Blind Randomized Controlled Trial

BackgroundThe preferred surgical procedure for treating morbid obesity is debated. Patient-reported outcome measures (PROMs) are relevant for evaluation of the optimal bariatric procedure.MethodsA total of 113 patients with BMI from 50 to 60 were randomly assigned to standard (n = 57) or distal (n = 56) Roux-en-Y gastric bypass (RYGB). Validated PROMS questionnaires were completed at baseline and 2 years after surgery. Data were analyzed using mixed models for repeated measures and the results are expressed as estimated means and mean changes.ResultsObesity-related quality of life improved significantly after both procedures, without significant between-group differences (− 0.4 (95% CI = − 8.4, 7.2) points, p = 0.88, ES = 0.06). Both groups had significant reductions in the number of weight-related symptoms and symptom distress score, with a mean group difference (95% CI) of 1.4 (− 0.3, 3.3) symptoms and 5.0 (2.9. 12.8) symptom distress score points. There were no between-group differences for uncontrolled eating (22.0 (17.2–26.7) vs. 28.9 (23.3–34.5) points), cognitive restraint (57.4 (52.0–62.7) vs. 62.1 (57.9–66.2) points), and emotional eating (26.8 (20.5–33.1) vs. 32.6 (25.5–39.7) points).The prevalence of anxiety was 33% after standard and 25% after distal RYGB (p = 0.53), and for depression 12 and 9%, respectively (p = 0.76).ConclusionsThere were no statistically significant differences between standard and distal RYGB 2 years post surgery regarding weight loss, obesity-related quality of life, weight-related symptoms, anxiety, depression, or eating behavior.Trial RegistrationClinical Trials.gov number NCT00821197

Standard vs Distal Roux-en-Y Gastric Bypass in Patients With Body Mass Index 50 to 60

Up to one-third of patients undergoing bariatric surgery have a body mass index (BMI) of more than 50. Following standard gastric bypass, many of these patients still have a BMI greater than 40 after peak weight loss. To assess the efficacy and safety of standard gastric bypass vs distal gastric bypass in patients with a BMI of 50 to 60. Double-blind, randomized clinical parallel-group trial at 2 tertiary care centers in Norway (Oslo University Hospital and Vestfold Hospital Trust) between May 2011 and April 2013. The study included 113 patients with a BMI of 50 to 60 aged 20 to 60 years. The 2-year follow-up was completed in May 2015. Standard gastric bypass (alimentary limb, 150 cm) and distal gastric bypass (common channel, 150 cm), both with a biliopancreatic limb of 50 cm and a gastric pouch of about 25 mL. Primary outcome was the change in BMI from baseline until 2 years after surgery. Secondary outcomes were cardiometabolic risk factors, nutritional outcomes, adverse events, gastrointestinal symptoms, and health-related quality of life. At baseline, the mean age of the patients was 40 years (95% CI, 38-41 years), 65% were women, mean BMI was 53.5 (95% CI, 52.9-54.0), and mean weight was 158.8 kg (95% CI, 155.3-162.3 kg). The mean reduction in BMI was 17.8 (95% CI, 16.9-18.6) after standard gastric bypass and 17.2 (95% CI, 16.3-18.0) after distal gastric bypass, and the mean between-group difference was 0.6 (95% CI, -0.6 to 1.8; P = .32). Reductions in mean levels of total and low-density lipoprotein cholesterol were greater after distal gastric bypass than standard gastric bypass, and between-group differences were 19 mg/dL (95% CI, 11-27 mg/dL ) and 28 mg/dL (95% CI, 21 to 34 mg/dL), respectively (P < .001 for both). Reductions in fasting glucose levels and hemoglobin A1c were greater after distal gastric bypass. Secondary hyperparathyroidism and loose stools were more frequent after distal gastric bypass. The number of adverse events and changes in health-related quality of life did not differ between the groups. Importantly, 1 patient developed liver failure and 2 patients developed protein-caloric malnutrition treated by elongation of the common channel following distal gastric bypass. Distal gastric bypass was not associated with a greater BMI reduction than standard gastric bypass 2 years after surgery. However, we observed different changes in cardiometabolic risk factors and nutritional markers between the groups. Clinicaltrials.gov Identifier: NCT00821197.

A102 - Proximal Versus Distal Gastric Bypass In Patients With Body Mass Index 50 to 60: A Double-Blind, Randomized Clinical Trial

A102 - Proximal Versus Distal Gastric Bypass In Patients With Body Mass Index 50 to 60: A Double-Blind, Randomized Clinical Trial

Perioperative Outcomes of Proximal and Distal Gastric Bypass in Patients with BMI Ranged 50-60 kg/m(2)--A Double-Blind, Randomized Controlled Trial.

BackgroundProximal Roux-en-Y gastric bypass may not ensure adequate weight loss in superobese patients. Bypassing a longer segment of the small bowel may increase weight loss. The objective of the study was to compare the perioperative outcomes of laparoscopic proximal and distal gastric bypass in a double-blind randomized controlled trial of superobese patients. The study was conducted at two public tertiary care obesity centers in Norway.MethodsPatients with body mass index (BMI) 50–60 kg/m2 were randomly assigned to a proximal (150 cm alimentary limb) or a distal (150 cm common channel) gastric bypass. The biliopancreatic limb was 50 cm in both operations. Patients and follow-up personnel were blinded to the type of procedure. Thirty-day outcomes including complications are reported.ResultsWe operated on 115 patients, of whom two were excluded at surgery, leaving 56 and 57 patients in the proximal group and distal group, respectively. The median (range) operating time was 72 (36–151) and 101 (59–227) min, respectively (p < 0.001). Two distal procedures were converted to laparotomy during the primary procedure. Median length of hospital stay was 2 (1–4) days in the proximal group and 2 (1–24) days in the distal group. The number of patients with complications and complications categorized according to the Contracted Accordion classification did not differ significantly. However, all six reoperations were performed in the distal group, of which three were completed by laparoscopy (p = 0.01 between groups). There were no deaths.ConclusionsIn superobese patients with BMI between 50 and 60 kg/m2, distal gastric bypass was associated with longer operating time and more severe complications resulting in reoperation than proximal gastric bypass.

367 Persistent Functional Deficits and Symptoms Among Long-Term Survivors of Colorectal Cancer Treated With Surgery and Multimodality Therapy: Differences by Age at Initial Diagnosis

S A T A b st ra ct s reoperations per year increased steadily from 3.1% in 2007 to 6.3% in 2012. Among patients undergoing reoperations 10,139 (50%) had previously undergone a laparoscopic adjustable band (LAGB) placement, 6411 (31%) a Roux-en-Y gastric bypass (RYGB), 444 (2%) a sleeve gastrectomy (SG), 1685 (8%) a vertical banded gastroplasty (VBG), and 236 (1.2%) a duodenal switch (DS). The operations were most commonly revised to a RYGB in 6801 (33.3%), LAGB (24.8%), SG 1684 (8.1%), DS 393 (1.9%), distal gastric bypass 259 (1.3%) and a group of other operations 6229 (30.6%). EWL at 1-year to RYGB was 27%, LAGB (15.4%), SG (16.5%) and DS (30.9%). The 30-day and 1-year morbidity and mortality rates of the four most common primary and reoperative bariatric operations are low and are shown in Table 1. Conclusions: Although, the rate of reoperations has steadily increased over the last five years to 6.3% per year, most bariatric surgery patients do not need reoperations. Among those who do, the complication rate is low and with satisfactory weight loss. These findings from a large database are critical to convince all stake-holders that outcomes after reoperative bariatric surgery are better than previously believed and are needed to help increase access of patients who need reoperations. Morbidity and Mortality Rates of Primary Bariatric Operations versus Reoperations

Weight Loss and Weight Regain—5-Year Follow-Up for Circular- vs. Linear-Stapled Gastrojejunostomy in Laparoscopic Roux-en-Y Gastric Bypass

Weight regain (WR) occurs in some patients after laparoscopic Roux-en-Y gastric bypass (LRYGBP). Loss of restriction due to dilation of the gastrojejunostomy (GJS) or the gastric pouch might be the main cause for WR. With different techniques available for the establishment of the GJS, the surgical technique might influence long-term success. We present a 5-year follow-up for weight loss and WR of a matched-pair study comparing circular stapled (CSA) to linear stapled (LSA) GJS in a series of 150 patients who underwent primary antecolic antegastric LRYGBP. Complete 5-year follow-up was obtained for 79% of the patients. Excess BMI loss (EBL) at 3months was better with the CSA (p = 0.02) and comparable thereafter. The 5-year %EBL was 67.3 ± 23.2 vs. 73.3 ± 24.3% (CSA vs. LSA, p = 0.19) WR of > 10kg from nadir was found in 24 patients (16%) with higher incidence in CSA than in LSA patients (20% vs. 12%). The %WR was comparable for both groups, 16 ± 13 vs. 15 ± 19% (CSA vs. LSA, p = 0.345). Eleven patients underwent surgical re-intervention for WR by placement of a non-adjustable band (n = 2), adjustable band (n = 7) and conversion to distal gastric bypass (n = 2). CSA and LSA lead to comparable weight loss in this 5-year follow-up. More patients in the CSA group had WR. Weight regain of more than 10kg was found in one out of seven patients within 5years postoperatively.

Life-Threatening Side Effects of Malabsorptive Procedures in Obese Patients Necessitating Conversion Surgery: a Review of 17 Cases

Background : malabsorptive surgery (MAS) can cause huge weight loss but is also known for its serious side effects. We investigated whether conversion surgery is an effective treatment for MAS-induced complications. Methods : we searched our hospital database for patients who underwent conversion surgery after MAS. Any complication was recorded till time of conversion. The conversion techniques and their effect on the course of the patients were analyzed and compared to the situation after MAS.Results : we identified 17 patients who suffered a wide range of complications after biliopancreatic diversion (BPD) (n = 11), biliopancreatic diversion with duodenal switch (BPD-DS) (n = 4), or distal gastric bypass (D-GBP) (n = 2). After a (mean ± SD) period of 6.0 ± 3.6 years the MAS was either converted to a gastric bypass (GBP) in 6 patients or an elongation of the common limb (ECL) in 9 patients. Two conversions were atypical. After a (mean ± SD) follow-up of 2.4 ± 2.5 years the majority of blood test results improved. The incidence of most complaints diminished except abdominal discomfort, critical illness polyneuropathy, need for total parenteral nutrition (TPN), wheelchair dependency, and asthenia. One patient died of irreversible liver failure after 3 liver transplantations. Two patients died of cachexia. The preferred conversion technique is still unclear.Conclusions : MAS can cause invalidating and life-threatening side effects. If there are signs of incipient deterioration in organ function and/or nutritional status, conversion surgery should not be delayed. Although we have the impression that early conversion causes better outcome, many patients experience lifelong postoperative complications.

Laparoscopic revision of common channel length for chronic diarrhea and malnutrition complicating distal gastric bypass

A 60-year-old woman who had undergone distal Roux-en-Y gastric bypass at our institution 9 years earlier presented after an 8-year absence with chronic diarrhea that had been disturbing her quality of life for the year before presentation. Her prebypass body mass index had been 65 kg/m2. She had received a 150-cm common channel constructed at the bypass. Her present weight was about 81 kg. She was having 3–4 watery bowel movements daily. She had used antidiarrheal agents, tried avoiding lactose, had undergone repeated colonoscopies, and had been treated with antibiotics by her primary care physician; all to no avail.

Laparoscopic Conversion of Roux-en-Y Gastric Bypass to Distal Gastric Bypass for Weight Regain

Weight regain after Roux-en-Y gastric bypass (RYGB) is one of the possible complications bariatric surgeons are confronted with. An option for enhancing weight loss is the conversion of RYGB into distal RYGB (DRYGB), which is a malabsorptive procedure. We report the technical strategy and the preliminary outcomes of conversion of RYGB to DRYGB by laparoscopy. Between April 2005 and November 2009, 7 patients benefited from laparoscopic conversion of RYGB to DRYGB for weight regain mainly due to a new dietary behavior, namely, polyphagia (eating too frequent meals). At the time of RYGB, the mean weight and BMI was 120.5 ± 26.4 kg and 43.2 ± 6.7 kg/m(2), respectively. Five patients suffered of obesity-related comorbidities. Mean interval time between RYGB and conversion was 41 ± 15.9 months. At the time of conversion, the mean weight, BMI, % excess weight loss were 100.7 ± 19.8 kg, 36.1 ± 4.8 kg/m(2), and 33.7% ± 12.1%, respectively. Obesity-related comorbidities at that time affected 4 patients. Mean operative time was 122.1 ± 34 minutes. There were no conversions to open surgery and no mortality. Postoperatively, 1 patient suffered of a bleeding. Mean hospital stay was 4.7 ± 2.5 days. After a mean follow-up of 19 ± 23.7 months, the mean weight, BMI, and % excess weight loss was 82.5 ± 19.7 kg, 29.5 ± 5.3 kg/m(2), and 57.6% ± 8.1%, respectively. Obesity-related comorbidities remained unchanged after the conversion in the 4 patients. One patient required a surgical reoperation for internal hernia. Conversion of RYGB to DRYGB for weight regain can safely be performed by laparoscopy, with satisfactory early results.