Reasons and Operative Outcomes After Reversal of Gastric Bypass and Jejunoileal Bypass

Abstract

Limited information is available regarding reversal of gastric bypass. While reversal will lead to weight regain and return of comorbid conditions, procedure reversal is sometimes necessary due to complications. The decision to reverse versus revise is difficult; currently, there are no established guidelines. The objective was to review one center's experience with reversals of gastric bypass and jejunoileal bypass procedures and identify potential indications as well as technical feasibility and short-term outcomes. A retrospective review of a prospectively collected database from 1999 to 2010 was conducted; 12 patients who underwent reversal of non-banding bariatric procedures were included. There was no major perioperative morbidity in elective patients; one patient whose reversal was part of a second-look operation had massive intestinal necrosis. There was one (8.3 %) non-procedure-related postoperative death. No leaks were identified in any of the reversals. Leak rates were compared with other revisional procedures such as reversals, revisions, and conversions, with no statistical significance regarding leak rates between all three groups; however, revisions and conversions were performed via open or laparoscopic approach, while reversals were performed exclusively via open approach. Reversals of bariatric (non-banding) procedures, either combined or purely malabsorptive, are technically challenging. Indications remain poorly defined. In our experience, short gut syndrome, renal failure, marginal ulceration, and malnutrition were the most common indications for reversal, differing from previously published data. Indications can depend on patient and surgeon preferences, but primarily on surgeon experience and type of complications. Based on this initial experience, these operations can be performed using the open approach with good outcomes.

Management of Excessive Weight Loss Following Laparoscopic Roux-en-Y Gastric Bypass: Clinical Algorithm and Surgical Techniques

“…In most instances, reoperations after bariatric surgery are performed for failure of weight loss, weight regain, and surgical complications [27]. Protein calorie malnutrition is not a common occurrence after LRYGB, and excessive weight loss after bariatric surgery is even less common.…”

“…More recently, the number of revisional surgeries being performed has increased secondary to the increased frequency of primary bariatric surgeries performed in the USA. Some of those revisions included bypass reversals because of post-operative complications [27,28].…”

Operative Strategies for Patients with Failed Primary Bariatric Procedures

“…The preoperative placement of a gastrostomy into the bypassed stomach can be a helpful tool to improve the preoperative status of the patient. Chousleb et al [35] reviewed patients who underwent RYGB reversal and jejunoileal bypass procedures, which were performed in 0.32% of their patient population. A total number of 12 patients were identified, of which 4 received a reversal of a jejunoileal bypass and 8 patients had an RYGB reversal due to severe metabolic complications with renal failure and/or malnutrition.…”

Jejunoileal bypass as the main procedure in the onset of immune-related conditions: the model of BADAS

“…Bypass reversal is curative in the majority of patients partially responding to pharmacological therapy [63,68,69]. In patients without bowel bypass, treatment of the underlying GI disease has contributed to remission [8].…”

“…Until now, published literature has reported large cohorts of patients still treated with JIB in selected patients in which different procedures are not available or, alternatively, on the basis of new suggested indications, such as patients affected by unresponsive Type 2 diabetes [68,80]. Thus, it is still possible that patients could undergo these surgical procedures and consequently develop immune-related diseases.…”