Combined Laparoscopic Revision of the Gastric Pouch and Distalization of the Roux Limb After Failure of Weight Loss Following Roux-en-Y Gastric Bypass

Apr 28, 2020Obesity surgery

Laparoscopic Surgery to Resize the Stomach and Adjust Intestine Length After Weight Loss Fails Following Gastric Bypass

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Abstract

At 1 year post-surgery, the patient's BMI decreased from 41.2 kg/m to 31.2 kg/m.

The patient underwent multiple weight-loss surgeries, including sleeve gastrectomy and Roux-en-Y gastric bypass, before the recent procedure.
A 3D volumetric CT scan measured the gastric pouch volume at 220 cm³ and the gastrojejunal anastomosis diameter at 20 mm.
The combined surgical approach involved resizing the gastric pouch and distalizing the Roux limb, creating a new gastric pouch of 30 cm.
No nutritional deficiencies were reported following the surgery.
The outcomes suggest that this technique may enhance weight loss by adding both restriction and malabsorption.

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PURPOSE: After failed Roux-en-Y gastric bypass (RYGB), the choice of a secondary procedure falls into many pathways: revision of the gastric pouch, distalization of the bypass (DRYGB), addition of an adjustable gastric band, and conversion to a duodenal switch (BPD/DS).

MATERIAL AND METHODS: We present the case of a 54-year-old man with initial BMI of 51.5 kg/m, who first underwent laparoscopic sleeve gastrectomy (SG) in 2010. In 2012, he underwent a RYGB procedure, and in 2015, a pouch resizing for weight regain. In 2018, he reached a BMI of 41.2 kg/m. A 3D volumetric CT scan measured a gastric pouch volume of 220 cmand a gastrojejunal anastomosis diameter of 20 mm. 2 2 3

RESULTS: As shown in the video, the patient underwent a combined revision of the gastric pouch and the gastrojejunal anastomosis associated to the distalization of the Roux limb. The gastrojejunal anastomosis is identified, and vertical division of the stomach is performed along a 36 French bougie, in order to create a 30 cmgastric pouch. Then, the jejunojejunal anastomosis is identified, and the Roux limb at the jejunojejunostomy is divided and transposed distally 100 cm to create a total alimentary length of 250 cm. The postoperative course was uneventful. At 1 year, his BMI was 31.2 kg/m. No nutritional deficiencies were noted. 3 2

CONCLUSION: Combined laparoscopic pouch resizing and distalization are safe and can lead to adequate weight loss. This technique allows the combination of an added restriction and malabsorption to the previous RYGB and could lead to an improved weight loss.

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Combined Laparoscopic Revision of the Gastric Pouch and Distalization of the Roux Limb After Failure of Weight Loss Following Roux-en-Y Gastric Bypass

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