Abstract
Introduction:
Presently, there is no general consensus about the optimal limb lengths for a failed laparoscopic Roux-en-Y gastric bypass (LRYGB) performed for morbid obesity. Usually, the length is chosen based on personal practice. A few studies document LRYGB revision for failed weight loss without serious nutritional sequelae. 1 –3 This video presents a validated technique in an initial pilot series with short-term follow-up.
Methods:
From 2013 to 2015, 11 patients (5 males and 6 females) required conversion from a primary LRYGB to a distal LRYGB. After measuring the total small bowel length, the following configuration was used: common limb length (CLL) of 100 cm, Roux limb of 2/3 and biliopancreatic limb (BPL) of 1/3 of the rest of the bowel, under the condition that the alimentary limb length (ALL) is at least 300 cm. Follow-up was the same as for the original LRYGB with the same supplementation as well.
Results:
Mean time since their initial LRYGB was 2.3 years (range 1.9–3.3 years). All patients were operated laparoscopically without any conversion to laparotomy. The percentage mean excess weight loss (EWL%) of the primary bypass for all patients was 22.2%. The mean EWL% in patients with follow-up of 12 months (eight patients) was 51.9% after revision. The total mean EWL at the time of the original LRYGB was 62.1%. The body mass index (BMI) and EWL of all 10 patients (the 11th patient has only 1 month of follow-up after operation) showed that their weight has either stabilized or continues to reduce even after the first 12 months. Nevertheless, two patients developed significant diarrhea (4–6/day) and two others had mild protein deficiency that resolved with supplements. One patient presented with severe nutritional sequelae and required a lengthening procedure of the CLL (from 100 to almost 330 cm), leaving the BPL as before (170 cm) and shortening the ALL (from 330 to 100 cm), with a complete remission of deficiencies 3 months later and reduction of bowel movements to 1–2 per day.
Conclusion:
Laparoscopic conversion of a failed LRYGB to a distal bypass using this technique seems to be efficient, but needs a larger series and longer follow-up to make further conclusions. Based on this initial pilot series, we recommend that an ALL between 350 and 400 cm might be a necessary for the best results, without significant deficiencies. 4
No competing financial interests exist.
Runtime of video: 9 mins 50 secs
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