Revision Roux-en-Y Gastric Bypass to Biliopancreatic Long-Limb Gastric Bypass for Inadequate Weight Response: Case Series and Analysis

Henry Buchwald, Danette M. Oien

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: The long-limb Roux-en-Y gastric bypass (LLRYGB) was introduced in 1987 as a salvage operation for inadequate weight loss after a standard Roux-en-Y gastric bypass (RYGB). Methods: We report on 53 consecutive patients (44 females) with conversion of a failed RYGB to a LLRYGB performed by a single surgeon between 2002 and 2014. No patient had an ascertainable anatomic abnormality to explain his/her weight regain. LLRYGB revision consisted of a 75-cm to 100-cm alimentary Roux limb and a 75-cm to 100-cm common channel; after 2011, in suitable patients, the Roux limb was lengthened to greater than 250 cm. Results: Average values for weight (lbs) were as follows: pre-original RYGB = 329; lowest measured after RYGB = 196; at time of LLRYGB = 285; and at 1, 2, 3, 4, >5 years post LLRYGB = 225, 207, 199, 197, 195, for a sustained weight loss >90 lbs. Average values for BMI (kg/m2) were as follows: pre-original RYGB = 54.3; lowest measured after RYGB = 32.3; at time of LLRYGB = 47.2; and at 1, 2, 3, 4, >5 years post LLRYGB = 37.1, 34.4, 33.0, 32.8, 31.4, for a sustained BMI reduction >16.5 kg/m2. Zero operative mortality; 3 (5.7%) late deaths; 7 (13.2%) 30-day complications; 33 (62.3%) long-term complications with 23 (43.4%) needing TPN; and 14 (26.4%) requiring operative revision. Conclusion: A salvage LLRYGB procedure can be performed safely and is weight successful, but fraught with long-term nutritional problems and a high necessity for revision. A Roux segment over 250 cm may improve outcomes.

Original languageEnglish (US)
Pages (from-to)2293-2302
Number of pages10
JournalObesity Surgery
Volume27
Issue number9
DOIs
StatePublished - Sep 1 2017

Fingerprint

Gastric Bypass
Extremities
Weights and Measures
Weight Loss
Limb Salvage

Keywords

  • Failed weight loss after Roux-en-Y gastric bypass (RYGB)
  • Long-limb Roux-en-Y gastric bypass (LLRYGB)
  • Revision after RYGB

PubMed: MeSH publication types

  • Journal Article

Cite this

Revision Roux-en-Y Gastric Bypass to Biliopancreatic Long-Limb Gastric Bypass for Inadequate Weight Response : Case Series and Analysis. / Buchwald, Henry; Oien, Danette M.

In: Obesity Surgery, Vol. 27, No. 9, 01.09.2017, p. 2293-2302.

Research output: Contribution to journalArticle

@article{9a9f9af17b1f4ad0bdcdbe282a874cd8,
title = "Revision Roux-en-Y Gastric Bypass to Biliopancreatic Long-Limb Gastric Bypass for Inadequate Weight Response: Case Series and Analysis",
abstract = "Background: The long-limb Roux-en-Y gastric bypass (LLRYGB) was introduced in 1987 as a salvage operation for inadequate weight loss after a standard Roux-en-Y gastric bypass (RYGB). Methods: We report on 53 consecutive patients (44 females) with conversion of a failed RYGB to a LLRYGB performed by a single surgeon between 2002 and 2014. No patient had an ascertainable anatomic abnormality to explain his/her weight regain. LLRYGB revision consisted of a 75-cm to 100-cm alimentary Roux limb and a 75-cm to 100-cm common channel; after 2011, in suitable patients, the Roux limb was lengthened to greater than 250 cm. Results: Average values for weight (lbs) were as follows: pre-original RYGB = 329; lowest measured after RYGB = 196; at time of LLRYGB = 285; and at 1, 2, 3, 4, >5 years post LLRYGB = 225, 207, 199, 197, 195, for a sustained weight loss >90 lbs. Average values for BMI (kg/m2) were as follows: pre-original RYGB = 54.3; lowest measured after RYGB = 32.3; at time of LLRYGB = 47.2; and at 1, 2, 3, 4, >5 years post LLRYGB = 37.1, 34.4, 33.0, 32.8, 31.4, for a sustained BMI reduction >16.5 kg/m2. Zero operative mortality; 3 (5.7{\%}) late deaths; 7 (13.2{\%}) 30-day complications; 33 (62.3{\%}) long-term complications with 23 (43.4{\%}) needing TPN; and 14 (26.4{\%}) requiring operative revision. Conclusion: A salvage LLRYGB procedure can be performed safely and is weight successful, but fraught with long-term nutritional problems and a high necessity for revision. A Roux segment over 250 cm may improve outcomes.",
keywords = "Failed weight loss after Roux-en-Y gastric bypass (RYGB), Long-limb Roux-en-Y gastric bypass (LLRYGB), Revision after RYGB",
author = "Henry Buchwald and Oien, {Danette M.}",
year = "2017",
month = "9",
day = "1",
doi = "10.1007/s11695-017-2658-x",
language = "English (US)",
volume = "27",
pages = "2293--2302",
journal = "Obesity Surgery",
issn = "0960-8923",
publisher = "Springer New York",
number = "9",

}

TY - JOUR

T1 - Revision Roux-en-Y Gastric Bypass to Biliopancreatic Long-Limb Gastric Bypass for Inadequate Weight Response

T2 - Case Series and Analysis

AU - Buchwald, Henry

AU - Oien, Danette M.

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Background: The long-limb Roux-en-Y gastric bypass (LLRYGB) was introduced in 1987 as a salvage operation for inadequate weight loss after a standard Roux-en-Y gastric bypass (RYGB). Methods: We report on 53 consecutive patients (44 females) with conversion of a failed RYGB to a LLRYGB performed by a single surgeon between 2002 and 2014. No patient had an ascertainable anatomic abnormality to explain his/her weight regain. LLRYGB revision consisted of a 75-cm to 100-cm alimentary Roux limb and a 75-cm to 100-cm common channel; after 2011, in suitable patients, the Roux limb was lengthened to greater than 250 cm. Results: Average values for weight (lbs) were as follows: pre-original RYGB = 329; lowest measured after RYGB = 196; at time of LLRYGB = 285; and at 1, 2, 3, 4, >5 years post LLRYGB = 225, 207, 199, 197, 195, for a sustained weight loss >90 lbs. Average values for BMI (kg/m2) were as follows: pre-original RYGB = 54.3; lowest measured after RYGB = 32.3; at time of LLRYGB = 47.2; and at 1, 2, 3, 4, >5 years post LLRYGB = 37.1, 34.4, 33.0, 32.8, 31.4, for a sustained BMI reduction >16.5 kg/m2. Zero operative mortality; 3 (5.7%) late deaths; 7 (13.2%) 30-day complications; 33 (62.3%) long-term complications with 23 (43.4%) needing TPN; and 14 (26.4%) requiring operative revision. Conclusion: A salvage LLRYGB procedure can be performed safely and is weight successful, but fraught with long-term nutritional problems and a high necessity for revision. A Roux segment over 250 cm may improve outcomes.

AB - Background: The long-limb Roux-en-Y gastric bypass (LLRYGB) was introduced in 1987 as a salvage operation for inadequate weight loss after a standard Roux-en-Y gastric bypass (RYGB). Methods: We report on 53 consecutive patients (44 females) with conversion of a failed RYGB to a LLRYGB performed by a single surgeon between 2002 and 2014. No patient had an ascertainable anatomic abnormality to explain his/her weight regain. LLRYGB revision consisted of a 75-cm to 100-cm alimentary Roux limb and a 75-cm to 100-cm common channel; after 2011, in suitable patients, the Roux limb was lengthened to greater than 250 cm. Results: Average values for weight (lbs) were as follows: pre-original RYGB = 329; lowest measured after RYGB = 196; at time of LLRYGB = 285; and at 1, 2, 3, 4, >5 years post LLRYGB = 225, 207, 199, 197, 195, for a sustained weight loss >90 lbs. Average values for BMI (kg/m2) were as follows: pre-original RYGB = 54.3; lowest measured after RYGB = 32.3; at time of LLRYGB = 47.2; and at 1, 2, 3, 4, >5 years post LLRYGB = 37.1, 34.4, 33.0, 32.8, 31.4, for a sustained BMI reduction >16.5 kg/m2. Zero operative mortality; 3 (5.7%) late deaths; 7 (13.2%) 30-day complications; 33 (62.3%) long-term complications with 23 (43.4%) needing TPN; and 14 (26.4%) requiring operative revision. Conclusion: A salvage LLRYGB procedure can be performed safely and is weight successful, but fraught with long-term nutritional problems and a high necessity for revision. A Roux segment over 250 cm may improve outcomes.

KW - Failed weight loss after Roux-en-Y gastric bypass (RYGB)

KW - Long-limb Roux-en-Y gastric bypass (LLRYGB)

KW - Revision after RYGB

UR - http://www.scopus.com/inward/record.url?scp=85017442079&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85017442079&partnerID=8YFLogxK

U2 - 10.1007/s11695-017-2658-x

DO - 10.1007/s11695-017-2658-x

M3 - Article

C2 - 28405877

AN - SCOPUS:85017442079

VL - 27

SP - 2293

EP - 2302

JO - Obesity Surgery

JF - Obesity Surgery

SN - 0960-8923

IS - 9

ER -