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Reversal of Roux-en-Y Gastric Bypass: A Multi-Centric Analysis of Indications, Techniques, and Surgical Outcomes

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Title: Reversal of Roux-en-Y Gastric Bypass: A Multi-Centric Analysis of Indications, Techniques, and Surgical Outcomes
Authors: Plath, Liane, Vannijvel, Marie, Okkema, Sietske, Deleus, Ellen, Lloyd, Aaron, Lo Menzo, Emanuele, Tadros, George, Raguz, Ivana, San Martin, Andres, Kraljevic, Marko, Mantziari, Styliani, Frey, Sebastien, Gensthaler, Lisa, Sammalkorpi, Henna, Garcia Galocha, Jose Luis, Sujathan, Vaishnavi, Zapata, Amalia, Tatarian, Talar, Wiggins, Tom, Bardisi, Ekhlas Samir, Goreux, Jean-Philippe, Seki, Yosuke, Kasama, Kazunori, Himpens, Jacques, Hollyman, Marianne, Welbourn, Richard, Aggarwal, Rajesh, Beekley, Alec, Sepulveda, Matias, Torres, Antonio, Juuti, Anne, Salminen, Paulina, Prager, Gerhard, Iannelli, Antonio, Suter, Michel, Peterli, Ralph, Boza, Camilo, Rosenthal, Raul, Higa, Kelvin, Lannoo, Matthias, Hazebroek, Eric, Pring, Christopher, Hawkins, Will, Slater, Guy, Dillemans, Bruno, Bueter, Marco, Gero, Daniel
Source: Obes Surg
Obesity surgery, vol. 35, no. 2, pp. 471-480
Publisher Information: Springer Science and Business Media LLC, 2025.
Publication Year: 2025
Subject Terms: Male, Adult, Reoperation, Abdominal pain, Conversion to normal anatomy, Complications, Roux-en-Y gastric bypass, Gastric Bypass, Outcomes, 1117 Public Health and Health Services, Body Mass Index, Postoperative Complications, Malabsorption Syndromes, Weight Loss, Humans, Gastric Bypass/methods, Gastric Bypass/adverse effects, Female, Middle Aged, Retrospective Studies, Obesity, Morbid/surgery, Reoperation/statistics & numerical data, Treatment Outcome, Postoperative Complications/epidemiology, Dumping Syndrome/etiology, Europe/epidemiology, United States/epidemiology, Abdominal Pain/etiology, Malabsorption Syndromes/surgery, Malabsorption Syndromes/etiology, Indications, Malnutrition, Recurrent weight gain, Reversal, Secondary bariatric surgery, BARIATRIC SURGERY, COMPLICATIONS, Science & Technology, 3210 Nutrition and dietetics, Research, 3202 Clinical sciences, 1103 Clinical Sciences, United States, Obesity, Morbid, Abdominal Pain, Europe, 4206 Public health, Dumping Syndrome, Surgery, Life Sciences & Biomedicine, OPERATIVE OUTCOMES
Description: Background Roux-en-Y gastric bypass may present long-term complications that require revisional surgery or even reversal to normal anatomy. Data on the indications, surgical technique, and outcomes of RYGB reversal remain scarce. Methods We identified 48 cases of RYGB reversals with complete 90-day follow-up within a multi-centric international retrospective database of elective secondary bariatric surgery. The operations were performed between 2010 and 2024 in high-volume referral centers in Europe and USA. Data were collected on body weight, associated diseases, and on surgical outcomes up to 1-year postoperatively. Results Patients were mainly female (81.3%) with a median age of 50 years (IQR 39–56). RYGB reversal was performed 7 years (median) after primary RYGB in patients with a BMI of 23.9 kg/m2 (IQR 20–27). Half of the patients underwent at least 1 bariatric revision before the reversal. Main indications for reversal were dumping syndrome (33.3%), excessive weight loss (29.2%), marginal ulcer (14.6%), malabsorption (12.5%), and abdominal pain (10.4%). Rate of conversion to open surgery was 8.3%, and the postoperative complications during the first year reached 50%, including 31.3% Clavien-Dindo grade I–II, 16.7% grade III–IV complications, and one death. At 1 year, the mean BMI of the cohort increased by 18% to 28.25 kg/m2; only 1 patient reached pre-RYGB BMI. Conclusion Although RYGB is a theoretically reversible procedure, normal anatomy is re-established only in selected cases which are refractory to medical therapy and often also to revisional bariatric surgery. RYGB reversals entail high morbidity, while the extent of recurrent weight gain at 1-year post-reversal seems to allow patients to remain below the threshold of severe obesity.
Document Type: Article
Other literature type
File Description: application/pdf
Language: English
ISSN: 1708-0428
0960-8923
DOI: 10.1007/s11695-024-07650-2
Access URL: https://pubmed.ncbi.nlm.nih.gov/39821905
http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_38CAE2FF637E2
https://serval.unil.ch/resource/serval:BIB_38CAE2FF637E.P001/REF.pdf
https://serval.unil.ch/notice/serval:BIB_38CAE2FF637E
Rights: CC BY
Accession Number: edsair.doi.dedup.....574f48a6343dec0cbd2ebb51cdaa9a6c
Database: OpenAIRE
Description
Abstract:Background Roux-en-Y gastric bypass may present long-term complications that require revisional surgery or even reversal to normal anatomy. Data on the indications, surgical technique, and outcomes of RYGB reversal remain scarce. Methods We identified 48 cases of RYGB reversals with complete 90-day follow-up within a multi-centric international retrospective database of elective secondary bariatric surgery. The operations were performed between 2010 and 2024 in high-volume referral centers in Europe and USA. Data were collected on body weight, associated diseases, and on surgical outcomes up to 1-year postoperatively. Results Patients were mainly female (81.3%) with a median age of 50 years (IQR 39–56). RYGB reversal was performed 7 years (median) after primary RYGB in patients with a BMI of 23.9 kg/m2 (IQR 20–27). Half of the patients underwent at least 1 bariatric revision before the reversal. Main indications for reversal were dumping syndrome (33.3%), excessive weight loss (29.2%), marginal ulcer (14.6%), malabsorption (12.5%), and abdominal pain (10.4%). Rate of conversion to open surgery was 8.3%, and the postoperative complications during the first year reached 50%, including 31.3% Clavien-Dindo grade I–II, 16.7% grade III–IV complications, and one death. At 1 year, the mean BMI of the cohort increased by 18% to 28.25 kg/m2; only 1 patient reached pre-RYGB BMI. Conclusion Although RYGB is a theoretically reversible procedure, normal anatomy is re-established only in selected cases which are refractory to medical therapy and often also to revisional bariatric surgery. RYGB reversals entail high morbidity, while the extent of recurrent weight gain at 1-year post-reversal seems to allow patients to remain below the threshold of severe obesity.
ISSN:17080428
09608923
DOI:10.1007/s11695-024-07650-2