Pouch Reshaping for Significant Weight Regain after Roux-en-Y Gastric Bypass.

Borbély, Yves Michael; Winkler, Carmen; Kröll, Dino; Nett, Philipp C. (2017). Pouch Reshaping for Significant Weight Regain after Roux-en-Y Gastric Bypass. Obesity surgery, 27(2), pp. 439-444. Springer 10.1007/s11695-016-2329-3

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BACKGROUND Significant weight regain after Roux-en-Y gastric bypass (RYGB) occurs in around 20 % of patients in the long term. Anatomical reasons include dilatation of the gastric pouch and/or the pouch-jejunal anastomosis, leading to loss of restriction. Pouch reshaping (PR) aims at reestablishing restriction with a subsequent feeling of satiety. This study reports the outcome of PR embedded in a multidisciplinary treatment pathway. METHODS Twenty-six patients after PR for weight regain >30 % following RYGB in a university hospital between October 2010 and March 2016 were analyzed. Excluded were patients with PR for gastro-gastric fistulae, hypoglycemia, candy cane syndrome, and concomitant alteration of limb lengths. PR consisted in laparoscopic lateral resection of the gastric pouch, the anastomosis and the proximal 5 cm of the alimentary limb over a 32F bougie. RESULTS Median follow-up after PR was 48 months (range 24-60). Median BMI at PR was 39.1 kg/m(2) (32.7-59.1). Median operation time was 85 min (25-190), and median length of stay was 3 days (1-35). Minor complications (grade ≤ 2) occurred in seven (27 %) patients and major complications (grade ≥ 3) in four patients (15 %). Nadir BMI and %EBMIL after PR were 32.9 kg/m(2) and 43.3 %, reached after a median of 12 months (3-48). Comorbidities were resolved in 81 %. After 48 months, median BMI was 33.8 kg/m(2) (20.4-49.2) and %EBMIL was 61.4 (39.1-121.2). CONCLUSIONS Used selectively in a multidisciplinary treatment pathway, PR leads to prolonged weight stabilization around the previous nadir. However, its associated perioperative morbidity must not be disregarded.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine

UniBE Contributor:

Borbély, Yves Michael; Winkler, Carmen; Kröll, Dino and Nett, Philipp C.

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0960-8923

Publisher:

Springer

Language:

English

Submitter:

Lilian Karin Smith-Wirth

Date Deposited:

17 Jul 2017 13:16

Last Modified:

17 Jul 2017 13:16

Publisher DOI:

10.1007/s11695-016-2329-3

PubMed ID:

27510586

Uncontrolled Keywords:

*Gastric bypass/methods; Body mass index; Humans; Laparoscopy; Obesity, morbid/surgery; Pouch reshaping; Pouch resizing; Reoperation; Revisional bariatric surgery; Roux-en-Y gastric bypass; Surgery; Weight gain; Weight loss; Weight recidivism; Weight regain

BORIS DOI:

10.7892/boris.93408

URI:

https://boris.unibe.ch/id/eprint/93408

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