Three-Year Outcomes of Revisional Laparoscopic Gastric Bypass after Failed Laparoscopic Sleeve Gastrectomy: a Case-Matched Analysis

Mar 8, 2017Obesity surgery

Three-Year Results of Revising Failed Sleeve Gastrectomy with Laparoscopic Gastric Bypass

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Abstract

At 3 years of follow-up, 74.4% excess weight loss was observed in primary LRYGB compared to 52.0% in revisional LRYGB.

Both primary LRYGB and revisional LRYGB groups had similar patient demographics and median BMI.
Coexisting comorbidities were rated similarly in patients undergoing either procedure.
The percentage of excess weight loss was significantly higher in primary LRYGB than in revisional LRYGB.
Similar improvements in coexisting comorbidities were observed in both surgical groups.
Revisional LRYGB is associated with effective weight loss and alleviation of refractory reflux symptoms.

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BACKGROUND: While previous studies suggest laparoscopic Roux-en-Y gastric bypass (LRYGB) as a reasonable treatment approach to address weight loss failure after laparoscopic sleeve gastrectomy (LSG), data focusing on long-term outcomes are still lacking. The purpose of this study was to evaluate weight and comorbidity outcomes comparing revisional LRYGB (rLRYGB) with primary LRYGB (pLRYGB).

METHODS: Retrospective single-centre case-matched analysis was conducted at a bariatric tertiary referral centre. Between January 2009 and July 2013, 239 patients were entered into a prospective database, and 32 patients undergoing rLRYGB (cases) were matched with 32 patients undergoing pLRYGB (controls) for sex, age and BMI. The end point was data at 3 years of follow-up. Thirty-one patients (12.9%) were lost to follow-up during the study period.

RESULTS: There were no significant differences in patient demographics or median BMI (kg/m) for pLRYGB or rLRYGB (42.8 ± 12.1 vs. 42.3 ± 11.5, respectively; p = 0.748). Coexisting comorbidities were rated similarly in both groups. At 3 years, the percentage of excess weight loss (74.4 ± 23.3 vs 52.0 ± 26, respectively; p = 0.007) was higher for pLRYGB than rLRYGB, while similar improvements of coexisting comorbidities could be observed. 2

CONCLUSION: rLRYGB is a feasible and practical surgical approach that allows effective weight loss at 3 years of follow-up and alleviates refractory reflux symptoms. Although weight loss is lower compared to pLRYGB, resolution or improvement of coexisting comorbidities appears similar. Therefore, rLRYGB seems to be a reliable procedure to address failure after LSG.

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Three-Year Outcomes of Revisional Laparoscopic Gastric Bypass after Failed Laparoscopic Sleeve Gastrectomy: a Case-Matched Analysis

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