Abstract
Background
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.
Methods
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.
Results
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.
Conclusion
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.
Keywords
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Article info
Publication history
Published online: February 23, 2011
Accepted:
January 13,
2011
Received:
May 13,
2010
Identification
Copyright
© 2011 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
