Abstract

Background: Worldwide prevalent over the past several decades, Obesity morbidities and health related adverse effects has been an increasing concern that lead to revolutionary advancements in the field of bariatric surgery. The long-term outcomes of the different techniques in have gained popularity in the last years. Although sleeve gastrectomy is being performed with increasing frequency as well as other restrictive procedures, failure or inadequate satisfactory outcome of these procedures became interestingly evident and thoroughly studied ranging from regaining of the preliminary lost weight, insufficient weight loss, GERD, and various other complications all of which determine a failure of the primary procedure.

Methods: In this prospective study 40 patients were included who underwent a revisional Roux-en-Y gastric bypass after failure of a different primary restrictive procedures (17 patients underwent sleeve gastrectomy, 21 patients underwent VBG and 2 patients underwent adjustable gastric banding) from January 2018 till January 2019 with a follow up period of one year till January 2020.

Results: Each patient had different indication for the revisional Roux en y gastric bypass conversion: 18 patients (45%) due to weight regain after 1ry weight loss, 14 patients (35%) due to insufficient weight loss, and 8 patients (20%) due to GERD. Roux en y gastric bypass was performed with significant reduction of both mean weight of the patients from 113.50 ± 9.92 kg to 98.65 ± 9.93 and 89.18 ± 9.84 after 6, and 12 months respectively and mean BMI from 39.06 ± 4.91 before the conversion to 33.93 ± 4.44 and 30.65 ± 4.11 at 6 and 12 months respectively. Moreover, co-morbidities such as Diabetes and Hypertension were markedly improved in addition to the lipid profile of most of the patients.

Conclusion: Roux en y gastric bypass is a safe surgical procedure with satisfactory outcomes and can be proposed as first line management choice to revise failed primary restrictive bariatric procedures.

Keywords: Laparoscopic sleeve gastrectomy; Roux-en-Y gastric bypass; Restrictive procedures; VBG; Adjustable gastric banding; Treatment failure; Revisional surgery