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Revisional Gastric Bypass for Failed Restrictive Procedures: Comparison of Single-Anastomosis (Mini-) and Roux-en-Y Gastric Bypass.
Obes Surg. 2018 04; 28(4):970-975.OS

Abstract

BACKGROUND

Ten to 50% of patients who received restrictive bariatric operations may require reoperation for unsatisfactory weight loss or weight regain. Failed restrictive procedures are usually managed with conversion to another bariatric procedure with a favor of conversion to laparoscopic gastric bypass. Our aim is to evaluate two different bypass techniques, laparoscopic RY gastric bypass (RYGB) versus single-anastomosis (mini-) gastric bypass (SAGB) as a revision option (R-RYGB and R-SAGB) for failed restrictive bariatric operations.

MATERIAL AND METHODS

From May 2001 to December 2015, a total of 116 patients with failed restrictive bariatric operations underwent laparoscopic revisional bypass surgery (81 R-SAGB and 35 R-RYGB). Among them, 81 were failed after vertical banded gastroplasty (VBG) and 35 were after adjustable gastric band (AGB). The demographic data, surgical parameters, and outcomes were studied.

RESULTS

The average age at revision surgery was 35.7 years (range 22-56), and the average body mass index (BMI) before reoperation was 37.2 kg/m2 (29.0-51.8). Revision surgery was performed after 58.8 months from the primary surgery on average (14-180 months). The main reasons for the revisions were weight regain (50.9%), inadequate weight loss (31%), and intolerance (18.1%). All of the procedures were completed laparoscopically as one-stage procedure. R-RYGB had significantly longer operative times than R-SAGB. Major complication occurred in 12 (10%) patients without significant difference between R-SAGB group and R-RYGB group. At 1 year follow-up, weight loss was better in R-SAGB than R-RYGB (76.8 vs. 32.9% EWL; p = 0.001). At 5 year follow-up, a significantly lower hemoglobin level was found in R-SAGB group (p = 0.03).

CONCLUSION

Both SAGB and RYGB are acceptable options for revising a restrictive type of bariatric procedures with equal safety profile. R-SAGB was shown to be a simpler procedure with better weight reduction than R-RYGB but anemia is a considerable complication at long-term follow-up.

Authors+Show Affiliations

Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan. Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia.Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan. wjlee_obessurg_tw@yahoo.com.tw.Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan.Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan.Department of International Business, ChienHsin University of Science and Technology, Taoyuan, Taiwan.Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan.

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article

Language

eng

PubMed ID

29101719

Citation

Almalki, Owaid M., et al. "Revisional Gastric Bypass for Failed Restrictive Procedures: Comparison of Single-Anastomosis (Mini-) and Roux-en-Y Gastric Bypass." Obesity Surgery, vol. 28, no. 4, 2018, pp. 970-975.
Almalki OM, Lee WJ, Chen JC, et al. Revisional Gastric Bypass for Failed Restrictive Procedures: Comparison of Single-Anastomosis (Mini-) and Roux-en-Y Gastric Bypass. Obes Surg. 2018;28(4):970-975.
Almalki, O. M., Lee, W. J., Chen, J. C., Ser, K. H., Lee, Y. C., & Chen, S. C. (2018). Revisional Gastric Bypass for Failed Restrictive Procedures: Comparison of Single-Anastomosis (Mini-) and Roux-en-Y Gastric Bypass. Obesity Surgery, 28(4), 970-975. https://doi.org/10.1007/s11695-017-2991-0
Almalki OM, et al. Revisional Gastric Bypass for Failed Restrictive Procedures: Comparison of Single-Anastomosis (Mini-) and Roux-en-Y Gastric Bypass. Obes Surg. 2018;28(4):970-975. PubMed PMID: 29101719.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Revisional Gastric Bypass for Failed Restrictive Procedures: Comparison of Single-Anastomosis (Mini-) and Roux-en-Y Gastric Bypass. AU - Almalki,Owaid M, AU - Lee,Wei-Jei, AU - Chen,Jung-Chien, AU - Ser,Kong-Han, AU - Lee,Yi-Chih, AU - Chen,Shu-Chun, PY - 2017/11/5/pubmed PY - 2018/12/12/medline PY - 2017/11/5/entrez KW - AGB KW - Complications KW - Morbid obesity KW - Revisions surgery KW - Roux-en-Y gastric bypass KW - Single-anastomosis gastric bypass KW - VBG KW - Weight loss SP - 970 EP - 975 JF - Obesity surgery JO - Obes Surg VL - 28 IS - 4 N2 - BACKGROUND: Ten to 50% of patients who received restrictive bariatric operations may require reoperation for unsatisfactory weight loss or weight regain. Failed restrictive procedures are usually managed with conversion to another bariatric procedure with a favor of conversion to laparoscopic gastric bypass. Our aim is to evaluate two different bypass techniques, laparoscopic RY gastric bypass (RYGB) versus single-anastomosis (mini-) gastric bypass (SAGB) as a revision option (R-RYGB and R-SAGB) for failed restrictive bariatric operations. MATERIAL AND METHODS: From May 2001 to December 2015, a total of 116 patients with failed restrictive bariatric operations underwent laparoscopic revisional bypass surgery (81 R-SAGB and 35 R-RYGB). Among them, 81 were failed after vertical banded gastroplasty (VBG) and 35 were after adjustable gastric band (AGB). The demographic data, surgical parameters, and outcomes were studied. RESULTS: The average age at revision surgery was 35.7 years (range 22-56), and the average body mass index (BMI) before reoperation was 37.2 kg/m2 (29.0-51.8). Revision surgery was performed after 58.8 months from the primary surgery on average (14-180 months). The main reasons for the revisions were weight regain (50.9%), inadequate weight loss (31%), and intolerance (18.1%). All of the procedures were completed laparoscopically as one-stage procedure. R-RYGB had significantly longer operative times than R-SAGB. Major complication occurred in 12 (10%) patients without significant difference between R-SAGB group and R-RYGB group. At 1 year follow-up, weight loss was better in R-SAGB than R-RYGB (76.8 vs. 32.9% EWL; p = 0.001). At 5 year follow-up, a significantly lower hemoglobin level was found in R-SAGB group (p = 0.03). CONCLUSION: Both SAGB and RYGB are acceptable options for revising a restrictive type of bariatric procedures with equal safety profile. R-SAGB was shown to be a simpler procedure with better weight reduction than R-RYGB but anemia is a considerable complication at long-term follow-up. SN - 1708-0428 UR - https://www.unboundmedicine.com/medline/citation/29101719/Revisional_Gastric_Bypass_for_Failed_Restrictive_Procedures:_Comparison_of_Single_Anastomosis__Mini___and_Roux_en_Y_Gastric_Bypass_ L2 - https://dx.doi.org/10.1007/s11695-017-2991-0 DB - PRIME DP - Unbound Medicine ER -