Revision to malabsorptive Roux-en-Y gastric bypass (MRNYGBP) provides long-term (10 years) durable weight loss in patients with failed anatomically intact gastric restrictive operations: long-term effectiveness of a malabsorptive Roux-en-Y gastric bypass in salvaging patients with poor weight loss or complications following gastroplasty and adjustable gastric bands

Abstract

Background: Twenty percent of gastric restrictive operations require revision. Conversion to Proximal Roux-en-Y gastric bypass (PRNYGBP) is associated with weight regain. Forty-one percent of these fail to achieve a body mass index (BMI) < 35. Few report follow-up (F/U) or quality of life (QOL) beyond 5 years. We report the long-term effectiveness of MRNYGBP as a revision.

Methods: Retrospective chart review of patients (1993-2005) with a failed gastric restrictive operation (S1) at least a year out from revision (S2) to a MRNYGBP: small lesser curve 22 ± 10 (11-55) cm(3) pouch, long biliopancreatic limb, 150 cm alimentary limb, 141 ± 24 (102-190) cm common channel. Staple-line disruptions were excluded.

Results: Thirty-eight (37 F, 1 M) patients aged 46 ± 8 (17-56) years underwent conversion to a MRYGBP 8 ± 5 (2-23) years after: gastroplasty 25, adjustable gastric band 13 for weight regain (79%), gastroesophageal reflux disease (GERD; 29%), and band problems (24%). S1 provided only 24 ± 25% excess weight loss (EWL; 5.9 ± 6.3 BMI drop) and caused GERD in 32% of patients (p = 0.0124). There were no deaths or leaks. BMI dropped from 41.4 ± 7.8 to 27.3 ± 5.6 (down 20.5 ± 8.3 from S1), 80.1 ± 23.3% EWL (n = 32) at year 1 (p < 0.0001). This was maintained for 10 years. BMI was 28 ± 4 (21.5-31.9), 75.6 ± 21.1% EWL (57.3-109.6) (n = 5) at 10 years. Super obese patients had better 9.95% EWL after S2 (p = 0.0359). QOL (5 = excellent): 4.5 ± 0.5 (3-5). F/U: 5.1 ± 3.3 (1-13) years with 83.3% F/U 10-year rate. Labs at 3 years (n = 10): Alb 3.8 ± 0.4, Prot 6.8 ± 0.6, Iron 47.6 ± 33.3, VitD 15.1 ± 7.43, PTH 54.5 ± 27.2, B12 620.1 ± 676.5, Hct 34 ± 4.3.

Conclusions: Revision MRNYGBP provides excellent durable long-term weight loss after failed gastric restrictive operations. Non-compliant patients are at a higher risk for malnutrition, anemia, and osteoporosis.