Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. Nov-Dec 1997;1(6):517-24; discussion 524-6.
doi: 10.1016/s1091-255x(97)80067-4.

Conversion of Proximal to Distal Gastric Bypass for Failed Gastric Bypass for Superobesity

Case Reports

Conversion of Proximal to Distal Gastric Bypass for Failed Gastric Bypass for Superobesity

H J Sugerman et al. J Gastrointest Surg. .


The purpose of this study was to analyze outcome following malabsorptive distal gastric bypass (D-GBP) in superobese patients who were reoperated for recurrent obesity comorbidity after a failed standard gastric bypass (S-GBP). Twenty-seven formerly superobese patients with a failed S-GBP converted to a D-GBP were studied. The small bowel was anastomosed 250 cm from the ileocecal valve to the disconnected Roux limb; the bypassed small intestine was connected to the ileum 50 cm from the ileocecal valve in five patients between 1985 and 1986 and 150 cm from the ileocecal valve in 22 patients thereafter. Comorbidity was reassessed yearly following conversion to D-GBP. Malnutrition occurred in all five patients with a 50 cm "common tract"; all required further revision and two died of hepatic failure. Three of 22 patients with a 150 cm common tract were reoperated with bowel lengthening because of malnutrition. Initial body mass index was 57+/-2 kg/m2 and fell from 46+/-2 kg/m2 before revision to 37+/-2 kg/m2 at 1 year and 32+/-2 kg/m2 at 5 years after revision; the percentage of excess weight lost went from 30+/-4% to 61+/-4% at 1 year and 69+/-5% at 5 years after revision. Preoperative comorbidity in patients undergoing revision included 14 with insulin-dependent type II diabetes mellitus, 11 with sleep apnea, 14 with hypoventilation, 13 with hypertension, and two with venous stasis ulcers. Obesity comorbidity was corrected within 1 year in all but two patients with hypertension and remained stable in all patients followed for 5 years. Revision of a failed S-GBP to a 150 cm common tract D-GBP corrects failed weight loss and severe obesity comorbidity but requires nutritional support to prevent protein-calorie malnutrition, iron and fat-soluble vitamin deficiencies, and further revision in some patients to correct malnutrition. A 50 cm common tract has an unacceptable morbidity and mortality.

Similar articles

See all similar articles

Cited by 54 articles

See all "Cited by" articles


    1. Surgery. 1988 Oct;104(4):806-12 - PubMed
    1. Arch Surg. 1989 Aug;124(8):941-6 - PubMed
    1. Am J Surg. 1993 Jan;165(1):155-60; discussion 160-2 - PubMed
    1. Obes Surg. 1993 Aug;3(3):289-295 - PubMed
    1. Ann Surg. 1987 Jun;205(6):613-24 - PubMed

Publication types