Background: Reversal of Roux-en-Y gastric bypass (RYGB) to normal anatomy (NA) is mandated in selected cases. However, reversal operations are associated with high complication rates and long operative times. In this study, we present the functional reversal (FR) as a novel method and an alternative to reversal to NA in treating the otherwise intractable symptoms rarely occurring after RYGB.
Methods: This is a retrospective cohort study of RYGB-patients with symptoms resistant to non-surgical treatment. Placement of gastrostomy tube for surgical evaluation and optimization of patients was usually done before FR. Resolution of symptoms was assessed along with efficacy and safety of the procedure. Achieved results were compared with data from the literature pertaining to reversal to NA.
Settings: High-volume bariatric center, Norway.
Results: Ten patients underwent FR. Mean follow-up after reversal was 18.4 months. Symptoms leading to operation improved in all patients. Eight patients suffered from hypoglycemia; resolution was seen in six and improvement of symptoms in the remaining two. Food intolerance, early dumping, nausea, postprandial abdominal pain, and malnutrition were alleviated in all patients. One leak was seen. Mean surgical time was 35.2 min. Total weight loss (TWL) and excess weight loss (EWL) after index RYGB were reduced 4.5% and 17.8%.
Conclusion: Functional reversal looks promising as an alternative to reversal to normal anatomy as it is technically simpler and safer and seems at least as effective in treating otherwise refractory symptoms.
Keywords: Conversion to normal anatomy; Failed gastric bypass; Functional reversal; Gastro-gastric fistula; Gastrostomy; Hypoglycemia; Hypoproteinemia; Malnutrition; Novel technique; Psychological intolerance; RYGB; Reversal; Roux-en-Y gastric bypass.