Gastric bypass reversal: a 7-year experience

Pernar, Luise I.M.; Kim, Julie; Shikora, Scott A.

doi:10.1016/j.soard.2016.03.032

Cited by 19 publications

(8 citation statements)

References 20 publications

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“…While reversal of RYGB is an uncommon procedure, the related literature demonstrates improvement in post-operative morbidities related to the post-RYGB anatomy, lending support to the concept that the gastric remnant retains much of its physiologic function [ 52 , 53 ]. In cases in which the post-RYGB patient develops severe complications (acute hypoglycemia, weight regain, intractable diarrhea, extreme dumping syndrome, cachexia), reversal of the bypass to normal anatomy commonly leads to resolution of symptoms [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

Reconstruction options following pancreaticoduodenectomy after Roux-en-Y gastric bypass: a systematic review

et al. 2018

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BackgroundObesity is a risk factor for pancreatic cancer which may be treated with Roux-en-Y gastric bypass and represents an increasing morbidity. Post-RYGB anatomy poses considerable challenges for reconstruction after pancreaticoduodenectomy (PD), a growing problem encountered by surgeons. We characterize specific strategies used for post-PD reconstruction in the RYGB patient.MethodsPubMed search was performed using MeSH terms “Gastric Bypass” and “Pancreaticoduodenectomy” between 2000 and 2018. Articles reporting cases of pancreaticoduodenectomy in post-RYGB patients were included and systematically reviewed for this study.ResultsThree case reports and five case series (25 patients) addressed PD after RYGB; we report one additional case. The typical post-gastric bypass PD patient is a woman in the sixth decade of life, presenting most commonly with pain (69.2%) and/or jaundice (53.8%), median 5 years after RYGB. Five post-PD reconstructive options are reported. Among these, the gastric remnant was resected in 18 cases (69.2%), with reconstruction of biliopancreatic drainage most commonly achieved using the distal jejunal segment of the pre-existing biliopancreatic limb (73.1%). Similarly, in the eight cases where the gastric remnant was spared (30.8%), drainage was most commonly performed using the distal jejunal segment of the biliopancreatic limb (50%). Among the 17 cases reporting follow-up data, median was 27 months.ConclusionReconstruction options after PD in the post-RYGB patient focus on resection or preservation gastric remnant, as well as creation of new biliopancreatic limb. Insufficient data exists to make recommendations regarding the optimal reconstruction option, yet surgeons must prepare for the possible clinical challenge. PD reconstruction post-RYGB requires evaluation through prospective studies.

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Section: Discussionmentioning

confidence: 99%

Reconstruction options following pancreaticoduodenectomy after Roux-en-Y gastric bypass: a systematic review

et al. 2018

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“…While this is uncommon after gastric bypass, it does occur in a subset of patients. In the short term, this can be treated with dietary supplementation or occasionally parenteral nutrition; while malnutrition is far and away from the most common reason for gastric bypass reversal, in some patients, intractable nausea and vomiting, recurrent postprandial hypoglycemia, or dumping syndrome may be the reason for reversal [81,82] . In some cases, these symptoms are representative of underlying issues with the gastro-jejunostomy, such as recurrent or chronic marginal ulceration.…”

Section: Revision Of the Gastro-jejunostomy For Excess Weight Loss Or...mentioning

confidence: 99%

“…The distal stomach is then mobilized in order to create a tension-free gastro-gastrostomy. The anastomosis is typically hand-sewn, which allows for more flexibility in terms of the position of the enterotomies and the length of the anastomosis [82,83] . The roux limb may be left in position, or resected just above the jejunojejunostomy.…”

Section: Revision Of the Gastro-jejunostomy For Excess Weight Loss Or...mentioning

confidence: 99%

Revisional bariatric surgery for chronic complications necessitates custom surgical solutions

Strong¹,

Guerrón²

2022

Mini-invasive Surg

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Bariatric surgery continues to grow as a treatment modality for obesity and weight-related comorbidities. The anatomic rearrangement can produce unique anatomic complications, as well as functional problems that are correctible with revisional operations. Understanding the unique subset of complications and the options available for correction can allow surgical solutions to be tailored to both the patient’s anatomy, and the symptoms or pathologies they are targeting. Revisional operations are becoming increasingly common, as the proportion of the general population who have previously undergone bariatric surgery continues to increase. Revisional bariatric operations are associated with an increased risk of complications and longer hospital stays, but in experienced centers can be performed safely, and often using minimally invasive approaches.

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“…A proven concept for the many patients when the aforementioned options fail is bariatric surgery, which has recently been shown to improve both NASH and overall survival [ 4 , 5 ]. Bariatric surgery, however, is associated with potentially severe harms requiring lifelong surveillance [ 6 , 7 ] and is not opted for by many patients although reversal is possible [ 8 ]. Reversible therapeutic approaches concentrate on excluding duodenal-jejunal resorption [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Bariatric Treatment with Duodenal-Jejunal Bypass Liner Improves Non-invasive Markers of Non-alcoholic Steatohepatitis

et al. 2022

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Purpose People with obesity often develop non-alcoholic fatty liver disease (NAFLD) and are at high risk of progression to non-alcoholic steatohepatitis (NASH). Few therapies are effective other than bariatric surgery. We therefore analyzed data from duodenal-jejunal bypass liner (DJBL) patients regarding steatosis, fibrosis, and NASH. Methods Consecutive DJBL patients with type 2 diabetes underwent standardized assessments up to device removal at 48 weeks. These included aspartate and alanine transaminase (AST, ALT), controlled attenuation parameter (CAP, for steatosis), and liver stiffness measurement (LSM, for fibrosis). The NAFLD fibrosis score (NFS), fibrosis-4 score (FIB4), and enhanced liver fibrosis (ELF) test were also used to assess fibrosis and the Fibroscan-AST (FAST) score to assess NASH. Mixed models were used and missing data were accounted for with multiple imputation. Results Thirty-two patients (18 female, mean age 55.1, mean BMI 40.2 kg/m2) were included. After 48 weeks, the change compared to baseline with 95% CI was a factor 0.74 (0.65 to 0.84) for AST, 0.63 (0.53 to 0.75) for ALT, and a difference of − 0.21 (− 0.28 to − 0.13) for FAST, all with p < 0.001. Fibrosis based on LSM, NFS, and ELF did not change whereas FIB4 exhibited slight improvement. Eight DJBL were explanted early due to device-related complications and eight complications led to hospitalization. Conclusions One year of DJBL therapy is associated with relevant improvements in non-invasive markers of steatosis and NASH, but not fibrosis, and is accompanied by a substantial number of complications. Given the lack of alternatives, DJBL deserves further attention. Graphical abstract

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Gastric bypass reversal: a 7-year experience

Cited by 19 publications

References 20 publications

Reconstruction options following pancreaticoduodenectomy after Roux-en-Y gastric bypass: a systematic review

Reconstruction options following pancreaticoduodenectomy after Roux-en-Y gastric bypass: a systematic review

Revisional bariatric surgery for chronic complications necessitates custom surgical solutions

Endoscopic Bariatric Treatment with Duodenal-Jejunal Bypass Liner Improves Non-invasive Markers of Non-alcoholic Steatohepatitis

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