Luise I M Pernar1, Julie J Kim2, Scott A Shikora3. 1. Department of Surgery, Brigham and Women's Hospital, Boston, MA. 2. Department of Surgery, Tufts Medical Center, Boston, MA. 3. Department of Surgery, Brigham and Women's Hospital, Boston, MA. Electronic address: sshikora@partners.org.
Abstract
BACKGROUND: After gastric bypass, some patients develop conditions that ultimately require reversal of the bypass. There are currently few publications on the topic to guide clinicians. OBJECTIVES: To describe the indications, techniques, and outcomes for gastric bypass reversal. SETTING: Two academic medical centers. METHODS: We conducted a retrospective chart review of all patients who underwent gastric bypass reversal at our institutions between 2008 and 2015. Information regarding the original operation, the indications for reversal, procedures performed, and the postoperative outcomes were collected and analyzed. RESULTS: Nineteen patients underwent gastric bypass reversal. All but 4 reversal operations were performed laparoscopically. The indications for reversal were malnutrition or excessive weight loss (6 patients); chronic nausea, vomiting, and abdominal pain (5); neuroglycopenia (4); massive small bowel loss due to internal hernia (3); and need for surveillance gastric endoscopy (1). In the perioperative period, 4 patients had a complication that required intervention. Five patients required additional delayed procedures. One patient was lost to follow-up. The remaining patients' mean follow-up was 22±18 months. Symptoms that prompted reversal of the gastric bypass resolved in the majority of patients. However, 1 patient's hypoglycemia did not resolve and 2 continued to have diarrhea. Six patients were weaned off of total parenteral nutrition. CONCLUSIONS: Laparoscopic gastric bypass reversal is feasible and well tolerated. The procedure can be employed to treat a variety of conditions that may occur after gastric bypass and the majority of patients benefit, with resolution of symptoms. In a carefully selected patient population, gastric bypass reversal should be considered if conservative approaches to adverse conditions fail. Copyright Â
BACKGROUND: After gastric bypass, some patients develop conditions that ultimately require reversal of the bypass. There are currently few publications on the topic to guide clinicians. OBJECTIVES: To describe the indications, techniques, and outcomes for gastric bypass reversal. SETTING: Two academic medical centers. METHODS: We conducted a retrospective chart review of all patients who underwent gastric bypass reversal at our institutions between 2008 and 2015. Information regarding the original operation, the indications for reversal, procedures performed, and the postoperative outcomes were collected and analyzed. RESULTS: Nineteen patients underwent gastric bypass reversal. All but 4 reversal operations were performed laparoscopically. The indications for reversal were malnutrition or excessive weight loss (6 patients); chronic nausea, vomiting, and abdominal pain (5); neuroglycopenia (4); massive small bowel loss due to internal hernia (3); and need for surveillance gastric endoscopy (1). In the perioperative period, 4 patients had a complication that required intervention. Five patients required additional delayed procedures. One patient was lost to follow-up. The remaining patients' mean follow-up was 22±18 months. Symptoms that prompted reversal of the gastric bypass resolved in the majority of patients. However, 1 patient's hypoglycemia did not resolve and 2 continued to have diarrhea. Six patients were weaned off of total parenteral nutrition. CONCLUSIONS: Laparoscopic gastric bypass reversal is feasible and well tolerated. The procedure can be employed to treat a variety of conditions that may occur after gastric bypass and the majority of patients benefit, with resolution of symptoms. In a carefully selected patient population, gastric bypass reversal should be considered if conservative approaches to adverse conditions fail. Copyright Â
Authors: Alejandro J Laguna Sanz; Christopher M Mulla; Kristen M Fowler; Emilie Cloutier; Allison B Goldfine; Brett Newswanger; Martin Cummins; Sunil Deshpande; Steven J Prestrelski; Poul Strange; Howard Zisser; Francis J Doyle; Eyal Dassau; Mary-Elizabeth Patti Journal: Diabetes Technol Ther Date: 2018-02 Impact factor: 6.118
Authors: Thomas Karlas; David Petroff; Jürgen Feisthammel; Sebastian Beer; Matthias Blüher; Tatjana Schütz; Ralf Lichtinghagen; Albrecht Hoffmeister; Johannes Wiegand Journal: Obes Surg Date: 2022-06-17 Impact factor: 3.479
Authors: William F Morano; Mohammad F Shaikh; Elizabeth M Gleeson; Alvaro Galvez; Marian Khalili; John Lieb; Elizabeth P Renza-Stingone; Wilbur B Bowne Journal: World J Surg Oncol Date: 2018-08-13 Impact factor: 2.754