Others may benefit from conversion to the more malabsorptive biliopancreatic diversion with duodenal switch (BPD-DS). Some benefit from a more restrictive procedure such as the addition of an adjustable band on the gastric pouch. A thorough assessment of dietary patterns is helpful (e.g., volume-eaters vs. The patients who never succeeded with a RYGB constitute a difficult population to treat. These are the patients who seem to benefit most from a revision procedure to eliminate the weight regain. Most patients report 50 to 60 percent EWL within two years and then subsequent weight regain. It is important to differentiate between patients who have never succeeded with the RYGB and patients who regained weight after significant excess weight loss (EWL) with the primary RYGB. This review describes the various revision options for failed RYGB, including emerging endoluminal therapies.Ĭareful nutritional and anatomic evaluation is helpful in understanding the causes of weight loss failure. Perhaps even more promising are new endoluminal therapies which avoid intra-abdominal surgery altogether.
In the current laparoscopic era, reoperative bariatric surgery has become more popular due to quicker recovery and decreased wound complications compared to open reoperative series. Revision bariatric surgery is technically complex, associated with a high incidence of morbidity, and historically has had questionable efficacy.
Indeed, the most common indication for reoperation after RYGB is inadequate weight loss.
Poor weight loss often leads patients to request a revision procedure. Particularly in superobese patients (BMI≥50Kg/m2), this failure rate can be as high as 40 to 60 percent, depending on how failure is defined. However, the long-term failure rate after RYGB is 20 to 35 percent. The Roux-en-Y gastric bypass (RYGB) is the most commonly performed bariatric procedure in the US. Both from Center for Obesity Surgery, Columbia University, New York-Presbyterian Hospital, New York, New Yorkĭisclosures: Autosuture (teaching), Ethicon Endosurgery (consulting), Bariatric partners (consulting), Inamed/Allergan (consulting), and Karl Storz Endoscopy (research).
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