Indications and outcomes of reversal of Roux-en-Y gastric bypass

Abstract

Background: Laparoscopic Roux-en-Y gastric bypass (RYGB) is proven to be a safe and effective treatment of obesity and related co-morbidities. However, there is a small group of patients who are unable to tolerate postoperative complications and ultimately undergo reversal procedures. This study demonstrates indications and postoperative outcomes in 8 patients following RYGB reversal.

Methods: Retrospective review of 8 patients who required RYGB reversal between July 2009 to October 2013. Data points included demographic characteristics, body mass index (BMI), co-morbidities, reasons for reversal and postoperative outcomes.

Results: All patients were female with a mean age of 44.5 ± 8.8 years (range, 35-63) and BMI of 30.0 ± 9.8 kg/m(2) (range, 19.3-43.8) before reversal. Reasons for reversal included recurrent anastomotic ulcer (n = 3), intractable nausea and emesis (n = 3), hypocalcemia (n = 1), and neuroglycopenia (n = 1). Mean period from RYGB to reversal was 127.8 ± 95.4 months (range, 21-298) and mean length of hospital stay following reversal was 5.1 ± 3.0 days (range, 2-11). One patient was lost to follow-up. Mean BMI at the last visit was 37.3 ± 12.6 kg/m(2) (range, 24.0-56.5). Two patients (28.6%) maintained the same weight 9 and 11 months after reversal. One returned to her pre-RYGB weight and 4 patients gained some of their weight back after reversal. Three (37.5%) patients required readmissions for abdominal pain and nausea/vomiting, and no patients required reoperations following RYGB reversal.

Conclusions: Reversal of RYGB to normal anatomy is reasonable in patients with severe or refractory complications.

Keywords: Complication; Indication; Reversal; Roux-en-Y gastric bypass.