Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jan-Feb;10(1):36-43.
doi: 10.1016/j.soard.2013.05.012. Epub 2013 Jun 29.

Laparoscopic reversal of Roux-en-Y gastric bypass: technique and utility for treatment of endocrine complications

Guilherme M Campos  1 , Martynas Ziemelis  2 , Rodis Paparodis  3 , Muhammed Ahmed  3 , Dawn Belt Davis  4
Affiliations

Laparoscopic reversal of Roux-en-Y gastric bypass: technique and utility for treatment of endocrine complications

Guilherme M Campos et al. Surg Obes Relat Dis. 2014 Jan-Feb.

Abstract

Background: The anatomic and physiologic changes with Roux-en-Y gastric bypass (RYGB) may lead to uncommon but occasionally difficult to treat complications such as hyperinsulinemic hypoglycemia with neuroglycopenia and recalcitrant hypocalcemia associated to hypoparathyroidism. Medical management of these complications is challenging. Laparoscopic reversal of RYGB anatomy with restoration of pyloric function and duodenal continuity is a potential treatment. The objective of this study was to present the indications, surgical technique, and clinical outcomes of laparoscopic reversal of RYGB.

Methods: Prospective study of consecutive patients offered laparoscopic reversal of RYGB.

Results: Five patients with remote laparoscopic RYGB underwent laparoscopic reversal of RYGB to normal anatomy (n = 2) or modified sleeve gastrectomy (n = 3). Indications were medically refractory hyperinsulinemic hypoglycemia with neuroglycopenia (n = 3), recalcitrant hypocalcemia with hypoparathyroidism (n = 1), and both conditions simultaneously (n = 1). Before reversal, all patients had a gastrostomy tube placed in the excluded stomach to document improvement of symptoms. Laparoscopic reversal was accomplished successfully in all patients. Three postoperative complications occurred: bleeding that required transfusion, gallstone pancreatitis, and a superficial trocar site infection. Average length of stay was 3 days. At a mean follow-up of 12 months (range 3 to 22), no additional episodes of neuroglycopenia occurred, average number of hypoglycemic episodes per week decreased from 18.5 ± 12.4 to 1.5 ± 1.9 (P = .05), and hypocalcemia became responsive to oral replacement therapy in both patients.

Conclusions: Laparoscopic reversal of RYGB to normal anatomy or modified sleeve gastrectomy is feasible and may be a therapeutic option for selected patients with medically refractory hyperinsulinemic hypoglycemia and/or recalcitrant hypocalcemia associated with hypoparathyroidism.

Keywords: Bariatric surgery; GLP-1; Gastric bypass; Hyperinsulinemic hypoglycemia; Hypocalcemia; Hypoglycemia; Hypoparathyroidism; Laparoscopic reversal; Nesidioblastosis; Reversal; Sleeve gastrectomy.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Division of the gastro-jejunostomy and Alimentary Limb just above the jejuno-jejunostomy using linear staplers.
Figure 2
Figure 2
Gastro-gastric anastomosis: 25mm trans-oral anvil in the gastric pouch being connected to the 4.8mm, 25 mm circular stapler inserted in the excluded stomach.
Figure 3
Figure 3
Final aspect – Laparoscopic reversal to “normal” anatomy.
Figure 4
Figure 4
Final aspect – Laparoscopic reversal to modified sleeve gastrectomy.
Figure 5
Figure 5
See this image and copyright information in PMC

References

    1. Rodieux F, Giusti V, D’Alessio DA, Suter M, Tappy L. Effects of gastric bypass and gastric banding on glucose kinetics and gut hormone release. Obesity (Silver Spring) 2008;16:298–305. - PubMed
    1. Salameh BS, Khoukaz MT, Bell RL. Metabolic and nutritional changes after bariatric surgery. Expert Rev Gastroenterol Hepatol. 2010;4:217–23. - PubMed
    1. Mingrone G, Castagneto-Gissey L. Mechanisms of early improvement/resolution of type 2 diabetes after bariatric surgery. Diabetes Metab. 2009;35(6 Pt 2):518–23. - PubMed
    1. Bal BS, Finelli FC, Shope TR, Koch TR. Nutritional deficiencies after bariatric surgery. Nat Rev Endocrinol. 2012;8:544–56. - PubMed
    1. Arterburn DE, Bogart A, Sherwood NE, et al. A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass. Obes Surg. 2013;23:93–102. - PMC - PubMed

Publication types

MeSH terms