Revision of Roux-en-Y gastric bypass to distal bypass for failed weight loss

Background: Weight loss failure after proximal Roux-en-Y gastric bypass (RYGB) occurs in ≤ 35% of cases. No consensus has been reached on the best revisional operation for these patients. Our objective was to review our data on the conversion to distal gastric bypass at a university-affiliated private practice in the United States.

Methods: A retrospective review was completed of 29 patients from 2002 to 2009 who had undergone conversion of RYGB to distal gastric bypass because of failure to lose weight, defined as a body mass index >35 kg/m(2) or a percentage of excess weight loss of <50%. The RYGB of each patient was converted to a 100-cm distal common limb with a total in-continuity length of 250 cm. Attention was primarily paid to the percentage of excess weight loss at each yearly follow-up visit and any metabolic complications.

Results: The average excess weight loss and body mass index were significantly improved from 26.6% and 48.1 kg/m(2) before revision to 60.9% and 35.3 kg/m(2) at 1 year and 68.8% and 31.5 kg/m(2) at 5 years. Of the 29 patients, 6 developed protein calorie malnutrition requiring parenteral nutrition, and 1 required reversal. Diabetes had completely resolved with the additional weight loss.

Conclusion: Revision of RYGB to distal gastric bypass can allow patients to achieve sustainable weight loss similar to what they were seeking from their primary surgery. From the results of the present series, the operation was safe, with no perioperative mortality or anastomotic complications. The development of protein calorie malnutrition and vitamin deficiencies is real, and patients require close monitoring and follow-up.