![]() This entails disconnecting the Roux limb and reconnecting it closer to the ileocecal valve, usually 50 to 150cm proximal to the ileocecal valve. Others recommend conversion of the failed RYGB to a distal gastric bypass. Muller, et al., described this laparoscopically (“pouch resizing”) and reported a mean BMI decrease of 3.9Kg/m2 at 11 months. Schwartz reported a 50-percent complication rate and negligible weight loss in 42 RYGB patients undergoing gastrojejunostomy revision. In Mason’s series, a significant number (15%) of these patients required an additional revision procedure. Storically revision for failed RYGB involved reduction of the gastrojejunostomy stoma. Surgical Therapies for Weight Loss Failure after RYGB However, most patients who present to us with weight regain after RYGB have technically intact anatomy (i.e., no evidence of gastrogastric fistula) with a dilated pouch and/or dilated stoma. Occasionally patients present with weight regain secondary to maladaptive eating behavior from stomal obstruction. We consider a pouch dilated if it is greater than 120cc in volume and a stoma dilated if it is greater than 2cm in diameter. These modalities also effectively diagnose staple line dehiscence and gastrogastric fistula. Endoscopy provides useful information about the pouch and stoma while upper GI detects esophageal and Roux limb abnormalities. In patients who present with failed RYGB, it is often useful to perform both upper endoscopy and upper gastrointestinal (GI) contrast studies, as they are complementary in the evaluation of anatomy and cause of weight gain after bariatric surgery. Others may benefit from conversion to the more malabsorptive biliopancreatic diversion with duodenal switch (BPD-DS). Some benefit from a more restrictive procedure such as the addition of an adjustable band on the gastric pouch. A thorough assessment of dietary patterns is helpful (e.g., volume-eaters vs. ![]() ![]() The patients who never succeeded with a RYGB constitute a difficult population to treat. These are the patients who seem to benefit most from a revision procedure to eliminate the weight regain. Most patients report 50 to 60 percent EWL within two years and then subsequent weight regain. It is important to differentiate between patients who have never succeeded with the RYGB and patients who regained weight after significant excess weight loss (EWL) with the primary RYGB. This review describes the various revision options for failed RYGB, including emerging endoluminal therapies.Ĭareful nutritional and anatomic evaluation is helpful in understanding the causes of weight loss failure. ![]() Perhaps even more promising are new endoluminal therapies which avoid intra-abdominal surgery altogether. In the current laparoscopic era, reoperative bariatric surgery has become more popular due to quicker recovery and decreased wound complications compared to open reoperative series. Revision bariatric surgery is technically complex, associated with a high incidence of morbidity, and historically has had questionable efficacy. Indeed, the most common indication for reoperation after RYGB is inadequate weight loss. Poor weight loss often leads patients to request a revision procedure. Particularly in superobese patients (BMI≥50Kg/m2), this failure rate can be as high as 40 to 60 percent, depending on how failure is defined. However, the long-term failure rate after RYGB is 20 to 35 percent. The Roux-en-Y gastric bypass (RYGB) is the most commonly performed bariatric procedure in the US. Chew thoroughly and drink only at least 30 minutes before or after eating.Both from Center for Obesity Surgery, Columbia University, New York-Presbyterian Hospital, New York, New Yorkĭisclosures: Autosuture (teaching), Ethicon Endosurgery (consulting), Bariatric partners (consulting), Inamed/Allergan (consulting), and Karl Storz Endoscopy (research). This can be avoided by eating a small meal at a time and eating slowly. A gastroesophageal reflux with the risk of vomiting may follow excessive/too rapid eating. This would help reduce the operative complications, accelerates wound healing and ensure sustainability post-surgery.įollowing gastric sleeve surgery, your stomach would have reduced by 80-90%, and you will experience early satiety following intake of little amount of meal. It is important to have started this dietary modification (pre-op diet) well enough before surgery. Refined sugars are high in calories and deficient in nutrients and therefore affect the adequacy of the nutrients in your diet.Īs part of your preparation for surgery, our nutritionist will send out our complete dietary plan for you. High protein diet will help reduce muscle breakdown and accelerates healing, while low carbohydrate will help reduce weight.
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