Three-Year Outcomes of Revisional Laparoscopic Gastric Bypass after Failed Laparoscopic Sleeve Gastrectomy: a Case-Matched Analysis

Obes Surg. 2017 Sep;27(9):2324-2330. doi: 10.1007/s11695-017-2631-8.


Background: While previous studies suggest laparoscopic Roux-en-Y gastric bypass (LRYGB) as a reasonable treatment approach to address weight loss failure after laparoscopic sleeve gastrectomy (LSG), data focusing on long-term outcomes are still lacking. The purpose of this study was to evaluate weight and comorbidity outcomes comparing revisional LRYGB (rLRYGB) with primary LRYGB (pLRYGB).

Methods: Retrospective single-centre case-matched analysis was conducted at a bariatric tertiary referral centre. Between January 2009 and July 2013, 239 patients were entered into a prospective database, and 32 patients undergoing rLRYGB (cases) were matched with 32 patients undergoing pLRYGB (controls) for sex, age and BMI. The end point was data at 3 years of follow-up. Thirty-one patients (12.9%) were lost to follow-up during the study period.

Results: There were no significant differences in patient demographics or median BMI (kg/m2) for pLRYGB or rLRYGB (42.8 ± 12.1 vs. 42.3 ± 11.5, respectively; p = 0.748). Coexisting comorbidities were rated similarly in both groups. At 3 years, the percentage of excess weight loss (74.4 ± 23.3 vs 52.0 ± 26, respectively; p = 0.007) was higher for pLRYGB than rLRYGB, while similar improvements of coexisting comorbidities could be observed.

Conclusion: rLRYGB is a feasible and practical surgical approach that allows effective weight loss at 3 years of follow-up and alleviates refractory reflux symptoms. Although weight loss is lower compared to pLRYGB, resolution or improvement of coexisting comorbidities appears similar. Therefore, rLRYGB seems to be a reliable procedure to address failure after LSG.

Keywords: Bariatric surgery; Conversion; Failed laparoscopic sleeve; Gastrectomy; Laparoscopic Roux-en-Y gastric bypass; Revisional surgery.

MeSH terms

  • Adult
  • Case-Control Studies
  • Comorbidity
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Gastrectomy / adverse effects*
  • Gastrectomy / methods
  • Gastrectomy / statistics & numerical data
  • Gastric Bypass / methods*
  • Gastric Bypass / statistics & numerical data
  • Humans
  • Laparoscopy / adverse effects
  • Laparoscopy / methods
  • Lost to Follow-Up
  • Male
  • Obesity, Morbid / epidemiology
  • Obesity, Morbid / surgery*
  • Reoperation* / methods
  • Reoperation* / rehabilitation
  • Retrospective Studies
  • Treatment Outcome
  • Weight Loss