I. D. Nwokeabia1, S. Purnell1, S. N. Zafar2, A. C. Obirieze2, G. Ortega2, K. Hughes1,2, T. M. Fullum1,2, D. D. Tran1,2 1Howard University College Of Medicine,Washington, DC, USA 2Howard University Hospital, Howard College Of Medicine,Department Of Surgery,Washington, DC, USA
Introduction: Weight regain has led to an increase in revision of Roux-en-Y gastric bypass (RYGB) surgeries. There is no standardized approach to revisional surgery after failed RYGB. We performed an exhaustive literature search to elucidate surgical revision options. Our objective was to evaluate outcomes and complications of various methods of revision after RYGB to identify the option with the best outcomes for failed primary RYGB.
Method: A systematic literature search was conducted using the following search tools and databases: PubMed, Google Scholar, Cochrane clinical trials database, Cochrane Review Database, EMBASE, and Allied and Complementary Medicine to identify all relevant studies describing revision after failed RYGB. Inclusion criteria comprises of revisional surgery only after the primary RYGB for weight regain.
Results: Of the 1200 articles found, only 799 were selected for our study. Of the 799, 26 studies, with a total of 987 patients, were included for a systematic review. Of the 26 studies, 6 were conversion to Distal Roux-en-y gastric bypass (DRYGB), 5 were revision of gastric pouch and anastomosis, 6 were revision using an adjustable gastric band, 3 were revision to biliopancreatic diversion/duodenal switch (BPD-DS), and 6 endoluminal procedures(i.e. stomaphyx). All studies revealed excess weight loss (EWL), varying from 20%–79.4% after 6–60 months follow-up. Mean EWL after revision at 12 months follow-up for DRYGB is 60.8%, gastric pouch revision 54.1%, gastric banding 34.6% and endoluminal procedures 38.1%. In the included cohort of study, major complications occurred in 15.6% (153/987) and minor complications in 13.0% (129/987). Band revision resulted in the lowest complications rate at 0.1% and DRYGB in the highest complication rate 0.4% when compared to the other revisional procedures. The overall mortality rate was 0.005% (5/987).
Conclusion: All 987 patients in the 26 studies reported significant weight loss after surgical revision for failed RYGB. However, of the five surgical revision options considered, revision to band resulted in the lowest mortality rate and the fewest major and minor complications. DRYGB resulted in the highest mean EWL, however it also had the highest complication rate of all the revisional procedures.