Yonta van der Burgh1, Abel Boerboom2, Hans de Boer3, Bart Witteman2, Frits Berends2, Eric Hazebroek2. 1. Department of Bariatric Surgery, Rijnstate Hospital/Vitalys Clinic, Arnhem, the Netherlands. Electronic address: YvanderBurgh@Rijnstate.nl. 2. Department of Bariatric Surgery, Rijnstate Hospital/Vitalys Clinic, Arnhem, the Netherlands. 3. Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands.
Abstract
BACKGROUND: After Roux-en-Y gastric bypass (RYGB), 15% to 35% of patients fail to lose sufficient weight. Distalization of the limbs of the RYGB (D-RYGB) with shortening of the common channel (CC), has been used to induce additional weight loss. However, this may increase the risk of malnutrition. OBJECTIVE: The aim of this study was to assess postoperative outcomes after D-RYGB with an alimentary limb of 250 to 300 cm and CC of 100 cm. SETTING: General hospital, specialized in bariatric surgery. METHODS: We retrospectively studied all patients who underwent revision of RYGB to D-RYGB between January 2014 and April 2018. Data were collected from medical records, including weight loss, nutritional deficiencies, and co-morbidities. Questionnaires on defecation pattern, quality of life, and patient satisfaction were obtained. RESULTS: Forty-seven patients were included. Total weight loss (%TWL) increased significantly from 12% to 30% after D-RYGB. In 62% of patients %TWL >25% was achieved. Patients with %TWL <25% after primary RYGB, lost significantly more weight than initially reached after RYGB. Diabetes and hypertension remission occurred in 67% and 50%, respectively. Five patients (11%) needed subsequent lengthening of the CC to 250 cm due to protein malnutrition or debilitating defecation patterns. Nutritional deficiencies were present in 89% of patients after D-RYGB despite the prescription of specialized multivitamins. CONCLUSION: Conversion of the primary RYGB to D-RYGB improves weight loss and co-morbidities in patients with insufficient weight loss after primary RYGB. After D-RYGB, nutritional complications and diarrhea are a risk. Based on this study, a modified D-RYGB with a longer CC of >200 cm will be considered.
BACKGROUND: After Roux-en-Y gastric bypass (RYGB), 15% to 35% of patients fail to lose sufficient weight. Distalization of the limbs of the RYGB (D-RYGB) with shortening of the common channel (CC), has been used to induce additional weight loss. However, this may increase the risk of malnutrition. OBJECTIVE: The aim of this study was to assess postoperative outcomes after D-RYGB with an alimentary limb of 250 to 300 cm and CC of 100 cm. SETTING: General hospital, specialized in bariatric surgery. METHODS: We retrospectively studied all patients who underwent revision of RYGB to D-RYGB between January 2014 and April 2018. Data were collected from medical records, including weight loss, nutritional deficiencies, and co-morbidities. Questionnaires on defecation pattern, quality of life, and patient satisfaction were obtained. RESULTS: Forty-seven patients were included. Total weight loss (%TWL) increased significantly from 12% to 30% after D-RYGB. In 62% of patients %TWL >25% was achieved. Patients with %TWL <25% after primary RYGB, lost significantly more weight than initially reached after RYGB. Diabetes and hypertension remission occurred in 67% and 50%, respectively. Five patients (11%) needed subsequent lengthening of the CC to 250 cm due to protein malnutrition or debilitating defecation patterns. Nutritional deficiencies were present in 89% of patients after D-RYGB despite the prescription of specialized multivitamins. CONCLUSION: Conversion of the primary RYGB to D-RYGB improves weight loss and co-morbidities in patients with insufficient weight loss after primary RYGB. After D-RYGB, nutritional complications and diarrhea are a risk. Based on this study, a modified D-RYGB with a longer CC of >200 cm will be considered.
Authors: Guillermo Borjas; Nestor Sánchez; Ali Urdaneta; Andres Maldonado; Eduardo Ramos; Edward Fumero; Jose DiGiorgio Journal: J Surg Case Rep Date: 2022-05-14
Authors: Daniel Moritz Felsenreich; Felix Benedikt Langer; Jakob Eichelter; Julia Jedamzik; Lisa Gensthaler; Larissa Nixdorf; Mahir Gachabayov; Aram Rojas; Natalie Vock; Marie Louise Zach; Gerhard Prager Journal: J Clin Med Date: 2021-02-10 Impact factor: 4.241