Surgical Therapy of Weight Regain Following Roux-en-Y Gastric Bypass

Abstract Background Roux-en-Y Gastric Bypass (RYGB) is a well-established surgical method for morbid obesity, however, weight regain (WR) after initially good results may be considered an issue, the treatment of which has found no consensus yet. Objectives The aim of this study was to compare the different surgical methods treating WR after RYGB that are used at the Vienna Medical University (MUW) in a larger number of patients, concerning further weight loss, complications, and re-operations. Methods This study includes all patients with RYGB who were re-operated due to WR at the MUW by 12/2016 (n=84). The follow-up rate was 93%. Four different approaches to treating WR after RYGB were taken: (1) pouch resizing, (2) pouch banding, (3) pouch resizing +pouch banding, (4) common limb shortening (i.e. distalization). Setting University hospital, Austria Results The mean maximum Excess Weight Loss (%EWL) referring to the WR procedure in the four groups was as follows: group 1: 69.0% ±35.2, group 2: 62.8% ±39.5, group 3: 83.1% ±30.9, and group 4: 81.5% ±41.6. Re-operations in the different groups: group 1 had two balloon dilatations (20%), group 2 (n=13) and group 3 (n=29) had five (38% and 17%) band removals each, and group 4 had nine reversal procedures due to malnutrition (30%). Conclusions There are non-significant differences in terms of additional weight loss between the different methods. However, differences lay in the areas of adverse symptoms and further re-operations. While there is no risk of malnutrition with pouch resizing, there is with distalization. Pouch banding (+/- resizing) poses a higher risk of dysphagia.