Background

A percentage of gastric bypass patients will seek additional options to address weight recidivism. Various revisional options may be feasible based on anatomical factors. We examine mid-term weight loss outcomes, effect on comorbidities, and need for intervention following revisional surgery.

Methods

Patients undergoing revision of their GB between 2014-2022 at two tertiary academic centers were included. Groups were analyzed based on surgical approach: 1) proximal (pouch+/-anastomosis stapling/resizing); 2) combined (proximal + small bowel distalization to reduce total alimentary limb length [TALL]).

Results

238 patients were included; n=208(87%) female, mean BMI of 43+-6, median age of 47 (IQR 15). Median follow up time was 3 years; 75% pts had >1 year of follow up. Proximal approach group N=145(61%); combined approach group N=93(39%). Average TALL after distalization was 360 cm. Median TBWL% by group was 10 (IQR 18) and 22 (IQR 16), respectively (p<0.001); %EBMIL was 27 (IQR 41) and 59 (IQR 41), respectively (p<0.001). Twenty-one percent of patients with hypertension either reduced or eliminated their medication dependence at last follow up (p=0.005). Morbidity requiring intervention was 4.6% (endoscopic [3%] or surgical [1.6%]).

Conclusions

Surgical revisions following Roux-en-y gastric bypass may include restricting the pouch/anastomosis as a stand-alone intervention or in combination with small bowel distalization to decrease the TALL. The combined approach offered significantly higher weight loss. Both options carry acceptable morbidity.