Roux-en-Y gastric bypass for the treatment of severe complications after omega-loop gastric bypass

Feb 23, 2017Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery

Using Roux-en-Y gastric bypass to treat serious problems after omega-loop gastric bypass

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Abstract

Fourteen patients (82%) experienced at least one disabling digestive disorder after omega-loop gastric bypass conversion to Roux-en-Y gastric bypass.

Conversion from omega-loop gastric bypass to Roux-en-Y gastric bypass may address severe complications such as undernutrition and disabling digestive disorders.
Before conversion, 58.8% of patients required nutritional support due to undernutrition.
At two years post-conversion, patients without undernutrition had a significant weight loss of 73.3% from their excess weight.
Patients with undernutrition saw an increase in average weight from 52.2 kg to 71 kg at two years, indicating improved nutritional status.
The conversion led to resolution of disabling digestive disorders in 85% of patients.
However, 41.1% of patients experienced major adverse events within 90 days of surgery.

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BACKGROUND: Omega-loop gastric bypass (OLGB) may be associated with severe complications, including anastomotic leak, refractory ulcer or stenosis, undernutrition, and disabling digestive disorders (chronic diarrhea, steatorrhea, bile reflux, and vomiting). OLGB conversion to Roux-en-Y gastric bypass (RYGB) was suggested to treat these complications.

OBJECTIVES: To evaluate the efficacy and risk of severe complications after OLGB conversion to RYGB.

SETTING: University hospital.

METHODS: Retrospective analysis between October 2011 and June 2016.

RESULTS: Seventeen patients underwent OLGB conversion to RYGB. Fourteen patients (82%) presented at least 1 disabling digestive disorder. Before conversion, 10 patients (58.8%) received nutritional support for undernutrition. There was no postoperative mortality. Seven patients (41.1%) developed major adverse events (<90 d). At conversion, the average weight, body mass index, and percent of excess weight loss for the population without undernutrition (n = 7) were 103.7±24 kg, 38.7±6.8 kg/m², and 37%±33%, respectively. These values were 85±18.3 kg, 30.6±4.7 kg/m², and 73.3%±21.5%, respectively, at 2 years. In patients with undernutrition (n = 10), the average weight, body mass index, and percent of excess weight loss were 52.2±16.5 kg, 18.7±5.9 kg/m², and 149.3%±46.5%, respectively, before nutritional support and 58.9±14.7 kg, 21.1±5.2 kg/m², and 132.7%±39.1%, respectively, at revisional surgery. At 2 years the values were 71±5.6 kg, 24.3±2.2 kg/m², and 104.6%±15.2%, respectively. The patients experienced significant improvements in hypoalbuminemia, anemia, and vitamin/trace element deficiencies. The disabling digestive disorders resolved in 85% of patients.

CONCLUSION: The conversion of OLGB to RYGB for severe complications allows for weight correction in patients with undernutrition, reduces disabling digestive disorders, and improves the nutritional status of patients. However, the conversion is associated with high morbidity.

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Roux-en-Y gastric bypass for the treatment of severe complications after omega-loop gastric bypass

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