Ahmad Ibrahim Elnahas1, Timothy D Jackson1, Dennis Hong2. 1. Department of Surgery, University of Toronto , Toronto, Ontario, Canada . 2. Department of General Surgery, McMaster University , Hamilton, Ontario, Canada .
Abstract
Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has emerged as the gold standard for the management of morbid obesity. Accordingly, patients who fail to lose weight after LRYGB present a difficult problem for the bariatric surgeons. A literature review was performed to evaluate the management options for this select bariatric population. Methods: A literature search was conducted in the EMBASE and MEDLINE databases using the most comprehensive timeline. All relevant articles were identified and full texts were obtained and reviewed. Results: Thirteen articles were retrieved based on key word searches. Management for weight failure following LRYGB included revision using the following options: laparoscopic adjustable gastric banding, pouch/anastomotic revision with or without endoluminal techniques, laparoscopic distal Roux-en-Y gastric bypass, and laparoscopic biliopancreatic diversion with duodenal switch. Laparoscopic sleeve gastrectomy may be considered in patients who fail LRYGB with nutritional deficiencies. Conclusion: Failed LRYGB should be managed based on the patient presentation and diagnostic evaluation. Patients may present with significant nutritional deficiencies/complications, failure to lose weight, or weight recidivism. A treatment algorithm is proposed based on the literature to guide bariatric surgeons with respect to management options. However, given the paucity of research with respect to this problem, additional studies are needed to provide more insight on the optimal surgical management.
Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has emerged as the gold standard for the management of morbid obesity. Accordingly, patients who fail to lose weight after LRYGB present a difficult problem for the bariatric surgeons. A literature review was performed to evaluate the management options for this select bariatric population. Methods: A literature search was conducted in the EMBASE and MEDLINE databases using the most comprehensive timeline. All relevant articles were identified and full texts were obtained and reviewed. Results: Thirteen articles were retrieved based on key word searches. Management for weight failure following LRYGB included revision using the following options: laparoscopic adjustable gastric banding, pouch/anastomotic revision with or without endoluminal techniques, laparoscopic distal Roux-en-Y gastric bypass, and laparoscopic biliopancreatic diversion with duodenal switch. Laparoscopic sleeve gastrectomy may be considered in patients who fail LRYGB with nutritional deficiencies. Conclusion: Failed LRYGB should be managed based on the patient presentation and diagnostic evaluation. Patients may present with significant nutritional deficiencies/complications, failure to lose weight, or weight recidivism. A treatment algorithm is proposed based on the literature to guide bariatric surgeons with respect to management options. However, given the paucity of research with respect to this problem, additional studies are needed to provide more insight on the optimal surgical management.
Authors: Santiago Horgan; Garth Jacobsen; G Derek Weiss; John S Oldham; Peter M Denk; Frank Borao; Steven Gorcey; Brad Watkins; John Mobley; Kari Thompson; Adam Spivack; Dave Voellinger; Chris Thompson; Lee Swanstrom; Paresh Shah; Greg Haber; Matthew Brengman; Gregory Schroder Journal: Surg Obes Relat Dis Date: 2010-02-13 Impact factor: 4.734
Authors: Eric J Vargas; Fateh Bazerbachi; Monika Rizk; Tarun Rustagi; Andres Acosta; Erik B Wilson; Todd Wilson; Manoel Galvao Neto; Natan Zundel; Manpreet S Mundi; Maria L Collazo-Clavell; Shah Meera; H S Abu-Lebdeh; Paul A Lorentz; Karen B Grothe; Matthew M Clark; Todd A Kellogg; Travis J McKenzie; Michael L Kendrick; Mark D Topazian; Christopher J Gostout; Barham K Abu Dayyeh Journal: Surg Endosc Date: 2017-06-29 Impact factor: 4.584