Background

Currently, there is no standardized approach for addressing weight regain following Roux-en-Y gastric bypass (RYGB). Combining jejuno-jejunostomy distalization (JJD) by shortening the total alimentary limb length (TALL) and elongating the biliopancreatic limb (BPL), along with sleeve resection of the gastrojejunostomy and gastric pouch (SRGJ) may offer a solution to these patients.ObjectivesTo demonstrate the bariatric outcomes of the largest series in the literature for this combined revisional procedure.SettingHigh-volume academic bariatric center of excellence.

Methods

Retrospective review of 61 patients who underwent this combined technique from 2020 to 2022. During the procedure, a gastrojejunostomy <2 cm, TALL >350 cm, and a new common channel (NCC) >200 cm were created. Postoperative bariatric outcomes and nutritional deficiencies were analyzed at one year.

Results

Median preoperative body mass index (BMI) was 42.59 Kg/m2. Lengths of the BPL before and after distalization were 50 cm and 175 cm, respectively. After revision, the NCC was 270 cm and the TALL was 400 cm. At 1, 6, and 12 months the median BMI of the cohort was reduced to 39.14, 35.55, and 32.9 Kg/m2, respectively. At 1-year, excess BMI loss (%EBMIL), excess weight loss (%EWL), and total weight loss (%TWL) were 54.47%, 51.87%, and 22.18%, respectively. Vitamin A (36.07%), D (50.82%), and K (32.79%) deficiencies were identified more frequently, but no reversal surgery was required. The 30-day complication rate was 4.9% (n=3).

Conclusions

The combination of distalization and SRGJ is safe and effective, with substantial improvement in weight loss at one year.