The gastro-jejunal anastomosis site influences dumping syndrome and weight regain in patients with obesity undergoing Laparoscopic Roux-en-Y Gastric Bypass

Oct 12, 2020Eating and weight disorders : EWD

How the connection site between stomach and small intestine affects dumping syndrome and weight regain after weight-loss surgery

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Abstract

In a study of 213 patients, the posterior gastric pouch anastomosis (PGJ) resulted in 94.13% excess weight loss compared to 77.59% for the anterior gastric pouch anastomosis (AGJ).

The mean follow-up time was significantly longer for the AGJ group at 81 ± 18 months compared to 27 ± 13 months for the PGJ group.
Dumping syndrome (DS) prevalence was significantly higher in the PGJ group at 76% versus 38% in the AGJ group.
Weight regain (WR) occurred in 16% of patients with AGJ compared to only 4% in those with PGJ.
The site of anastomosis was identified as an independent predictor of both DS and WR.
Obesity-related complications improved post-surgery regardless of the anastomosis type.

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PURPOSE: The Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is an effective weight loss procedure. The gastro-jejunal (GJ) anastomosis required can be performed on the anterior or posterior gastric pouch wall. No studies have compared these variants in terms of efficacy and onset of dumping syndrome (DS) and weight regain (WR). We aimed at assessing the prevalence of DS in relation to the site of anastomosis together with identifying prognostic factors of DS and WR.

METHODS: Patients who had undergone LRYGB with anterior (AGJ) or posterior (PGJ) anastomosis in 2010-2019 were retrospectively analyzed. We collected demographic data, medical history and the prevalence of DS evaluated through the Sigstad Score, together with WR data.

RESULTS: 213 patients were enrolled, of which 51.6% had an AGJ and 48.4% had a PGJ. The mean follow-up time was 81 ± 18 and 27 ± 13 months in the AGJ and PGJ group, respectively (p < 0.0001). Excess weight loss was 77.59% and 94.13% in patients with AGJ and PGJ, respectively (p < 0.001). WR rate was 16% and 4% in the AGJ and PGJ population, respectively (p < 0.001). DS prevalence was 38% and 76% in the AGJ and the PGJ population, respectively (p < 0.0001). The site of anastomosis was identified as an independent predictor of DS (OR5.15; 95% CI 2.82-9.41; p < 0.0001) and WR (OR5.31; 95% CI 2.32-12.15; p < 0.0001). Obesity-related complications significantly improved after surgery independent of the anastomosis site.

CONCLUSION: LRYGB is effective in determining long-term weight loss and improvement of complications. AGJ is associated with lower prevalence of DS but more frequent WR. The anastomosis site is a factor to be considered when performing LRYGB.

LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

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The gastro-jejunal anastomosis site influences dumping syndrome and weight regain in patients with obesity undergoing Laparoscopic Roux-en-Y Gastric Bypass

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