Indications and outcomes of reversal of Roux-en-Y gastric bypass

Apr 13, 2015Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery

Reasons for and results of reversing Roux-en-Y gastric bypass surgery

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Abstract

All 8 patients who underwent RYGB reversal were female with a mean age of 44.5 years.

Reasons for reversal included recurrent anastomotic ulcer (3 patients), intractable nausea and vomiting (3 patients), hypocalcemia (1 patient), and neuroglycopenia (1 patient).
The average time from RYGB to reversal was 127.8 months.
Post-reversal, the average hospital stay was 5.1 days.
At the last follow-up, the mean BMI increased to 37.3 kg/m².
Two patients (28.6%) maintained their weight after 9 and 11 months, while four patients regained some weight.
Three patients (37.5%) were readmitted for abdominal pain and nausea/vomiting, but no patients required reoperations.

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BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (RYGB) is proven to be a safe and effective treatment of obesity and related co-morbidities. However, there is a small group of patients who are unable to tolerate postoperative complications and ultimately undergo reversal procedures. This study demonstrates indications and postoperative outcomes in 8 patients following RYGB reversal.

METHODS: Retrospective review of 8 patients who required RYGB reversal between July 2009 to October 2013. Data points included demographic characteristics, body mass index (BMI), co-morbidities, reasons for reversal and postoperative outcomes.

RESULTS: All patients were female with a mean age of 44.5 ± 8.8 years (range, 35-63) and BMI of 30.0 ± 9.8 kg/m(2) (range, 19.3-43.8) before reversal. Reasons for reversal included recurrent anastomotic ulcer (n = 3), intractable nausea and emesis (n = 3), hypocalcemia (n = 1), and neuroglycopenia (n = 1). Mean period from RYGB to reversal was 127.8 ± 95.4 months (range, 21-298) and mean length of hospital stay following reversal was 5.1 ± 3.0 days (range, 2-11). One patient was lost to follow-up. Mean BMI at the last visit was 37.3 ± 12.6 kg/m(2) (range, 24.0-56.5). Two patients (28.6%) maintained the same weight 9 and 11 months after reversal. One returned to her pre-RYGB weight and 4 patients gained some of their weight back after reversal. Three (37.5%) patients required readmissions for abdominal pain and nausea/vomiting, and no patients required reoperations following RYGB reversal.

CONCLUSIONS: Reversal of RYGB to normal anatomy is reasonable in patients with severe or refractory complications.

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Indications and outcomes of reversal of Roux-en-Y gastric bypass

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