Highlights
- •Forty-seven patients had revisional surgery from primary gastric bypass to distal gastric bypass (D-RYGB) with an alimentary limb of 250-300 cm and common channel of 100 cm.
- •Total weight loss (TWL) increased significantly from 12% to 30% after D-RYGB and in 62% of patients %TWL>25% was achieved.
- •Nutritional deficiencies were present in 89% of patients after D-RYGB despite the prescription of specialized multivitamins.
- •Five patients (11%) needed subsequent lengthening of the common channel to 250 cm due to protein malnutrition or a debilitating defecation pattern.
- •The results of our study imply that a longer common channel (>200 cm) might be a better option.
Abstract
Background
After Roux-en-Y gastric bypass (RYGB), 15% to 35% of patients fail to lose sufficient
weight. Distalization of the limbs of the RYGB (D-RYGB) with shortening of the common
channel (CC), has been used to induce additional weight loss. However, this may increase
the risk of malnutrition.
Objective
The aim of this study was to assess postoperative outcomes after D-RYGB with an alimentary
limb of 250 to 300 cm and CC of 100 cm.
Setting
General hospital, specialized in bariatric surgery.
Methods
We retrospectively studied all patients who underwent revision of RYGB to D-RYGB between
January 2014 and April 2018. Data were collected from medical records, including weight
loss, nutritional deficiencies, and co-morbidities. Questionnaires on defecation pattern,
quality of life, and patient satisfaction were obtained.
Results
Forty-seven patients were included. Total weight loss (%TWL) increased significantly
from 12% to 30% after D-RYGB. In 62% of patients %TWL >25% was achieved. Patients
with %TWL <25% after primary RYGB, lost significantly more weight than initially reached
after RYGB. Diabetes and hypertension remission occurred in 67% and 50%, respectively.
Five patients (11%) needed subsequent lengthening of the CC to 250 cm due to protein
malnutrition or debilitating defecation patterns. Nutritional deficiencies were present
in 89% of patients after D-RYGB despite the prescription of specialized multivitamins.
Conclusion
Conversion of the primary RYGB to D-RYGB improves weight loss and co-morbidities in
patients with insufficient weight loss after primary RYGB. After D-RYGB, nutritional
complications and diarrhea are a risk. Based on this study, a modified D-RYGB with
a longer CC of >200 cm will be considered.
Key words
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Article info
Publication history
Published online: December 17, 2019
Accepted:
December 4,
2019
Received:
September 25,
2019
Footnotes
Y.G.R. van der Burgh, M.D., M.Sc. and A.B. Boerboom, M.D. contributed equally to this work.
Identification
Copyright
© 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
ScienceDirect
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- Comment on: Weight loss and malnutrition after conversion of the primary Roux-en-Y gastric bypass to distal gastric bypass in patients with morbid obesitySurgery for Obesity and Related DiseasesVol. 16Issue 5
- PreviewIn the article “Weight Loss and Malnutrition After Conversion of the Primary Roux-en-Y Gastric Bypass to Distal Gastric Bypass in Patients with Morbid Obesity,” the authors are to be congratulated for adding to our knowledge of using distalization techniques to enhance weight loss and co-morbidity resolution after previous standard proximal gastric bypass [1]. They have shown conversion of primary RYGB to a form of distal RYGB using a relatively short common channel of 100 cm and a relatively long alimentary limb of 250 cm improves weight loss and remission of co-morbidities.
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