Outcomes of reversal of malabsorptive and maldigestive bariatric procedures: a single center experience and a systematic review

Abstract

Background: A small proportion of patients undergoing malabsorptive or maldigestive bariatric interventions experience excessive weight loss and/or side effects. Some patients with recurrent comorbidities or severe metabolic derangements require a reversal to normal anatomy or physiology.

Objectives: To analyze indications, surgical techniques, and outcomes of reversal after malabsorptive or maldigestive surgery.

Setting: Academic institution, United States.

Methods: Single-center retrospective analysis and systematic literature review of reversal after malabsorptive and maldigestive bariatric surgery.

Results: From January 2005 until November 2022, 19 patients underwent a reversal of malabsorptive or maldigestive surgery to normal anatomy (15 Roux-en-Y gastric bypass, 4 jejunoileal bypass). The median age was 52 years (21; 74), and 80% of patients were female. Median body mass index (BMI) was 23 kg/m2 (17; 38) before reversal and 28 kg/m2 (17; 39) after reversal. Indication for reversal was often multifactorial but the most common indications were malnutrition (53%) with intractable diarrhea (42%) or hypoglycemia/dumping syndrome (37%). The most common reversal technique was a single anastomosis gastric bypass reversal (SARR procedure). Postoperative morbidity was 53%, with one major complication requiring reoperation (5%). With the exception of 4 patients who were lost during follow-up, all patients had improvement/resolution of symptoms. Weight regain occurred in three patients (16%), and one patient required further weight loss intervention (sleeve gastrectomy [SG]). Median follow-up time was 6 months (1; 206).

Conclusion: Reversal of a malabsorptive or maldigestive procedure due to metabolic complications is an effective and safe treatment modality. Because of the surgical complexity and its related postoperative morbidity, careful patient selection is essential to ensure a favorable postoperative outcome.

Keywords: Biliopancreatic diversion with duodenal switch; Jejunoileal gastric bypass; Malabsorption; Malabsorptive bariatric surgery; Maldigestive bariatric surgery; One-anastomosis gastric bypass; Reversal; Roux-en-Y gastric bypass.