Approximately 20–50% of patients regain weight 3–5 years after Roux-en-Y gastric bypass (RYGB) surgery. Gastric-gastric fistulas and dilation of the gastrojejunostomy and gastric pouch have been reported in these patients. Traditional revision surgery after RYGB has greater morbidity and mortality compared with the index bariatric procedure. We studied our initial results with revision of obesity surgery using an endoscopic platform in a community hospital setting.
A retrospective review was performed of patients who had undergone this endoscopic revisional procedure secondary to significant weight regain with or without gastric-gastric fistula. All patients underwent revision of the gastrojejunostomy and/or closure of the gastric-gastric fistula using this minimally invasive approach.
A total of 37 consecutive patients (36 women) with a mean age of 45 years and mean weight regain of 15.1 ± 10.0 kg were included in the present study. The mean interval between RYGB and revision was 5.2 years (range 1–11). The mean preoperative and postoperative stomal size was 21.5 and 10 mm, respectively. Anchors were successfully placed in all patients. The mean follow-up period was 4.69 months (range 2–10). The mean percentage of excess body weight loss was 23.5% ± 66.4%. No immediate complications developed. Two patients underwent endoscopic dilation of the stoma because of persistent meal intolerance. Three gastric-gastric fistulas were successfully closed.
Revision of gastrojejunostomy after RYGB can be safely undertaken using this endoscopic platform. The short-term follow-up results showed clinically significant weight loss. Long-term follow-up is needed. Closure of gastric-gastric fistulas can also be achieved using this procedure.
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- Long-term weight regain after gastric bypass: a 5-year prospective study.Obes Surg. 2008; 18: 648-651
- Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years.Ann Surg. 2006; 244: 734-740
- Medical management of obesity: present and future therapy.J Gastrointest Surg. 2003; 7: 464-467
- Laparoscopic Roux-en-Y gastric bypass as a revision procedure after restrictive bariatric surgery.Obes Surg. 2008; 18: 1539-1543
- Adjustable gastric band placed around gastric bypass pouch as revision operation for failed gastric bypass.Surg Obes Relat Dis. 2009; 5: 38-42
- Factors associated with weight loss after gastric bypass.Arch Surg. 2008; 143: 877-884
- Weight gain after bariatric surgery as a result of a large gastric stoma: endotherapy with sodium morrhuate may prevent the need for surgical revision.Gastrointest Endosc. 2007; 66: 240-245
- Size matters; gastric pouch size correlates with weight loss after laparoscopic Roux-en-Y surgery.Surg Endosc. 2007; 21: 1397-1402
- Natural orifice surgery: initial US experience utilizing the Stomaphyx™ device to reduce gastric pouches after Roux-en-y gastric bypass.Surg Endosc. 2010; 24: 223-228
- Treatment of weight regain after gastric bypass surgery when using a new endoscopic platform: initial experience and early outcomes.Gastrointest Endosc. 2009; 70: 440-444
- Minimal reporting requirements for weight loss: current methods not ideal.Obes Surg. 2005; 15: 1034-1039
- Incisionless revision of post Roux-en-Y bypass stomal and pouch dilation: multi-center registry results.Surg Obes Relat Dis. 2010; 6: 290-295
- Prospective single-site case series utilizing an endolumenal tissue anchoring system for revision of post-RYGB stomal and pouch dilatation.Surg Endosc. 2010; 24: 2308-2313
- How much EWL is enough? A Bayesian analysis to determine minimal EWL to deliver improvement/resolution of comorbidities after laparoscopic adjustable gastric banding in patients with BMI 30–40.Surg Obes Relat Dis. 2008; PL-17: 295
- Endoluminal procedures for bariatric patients: expectations among bariatric surgeons.Surg Obes Relat Dis. 2009; 5: 231-236
- Comparison of 30-day outcomes after non-LapBand primary and revisional bariatric surgical procedures from the Longitudinal Assessment of Bariatric Surgery study.Surg Obes Relat Dis. 2010; 6: 22-30
- Revisional bariatric surgery at a single institution.Am J Surg. 2010; 200: 651-654
Published online: February 23, 2011
Accepted: January 13, 2011
Received: May 13, 2010
© 2011 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.