Revision of Roux-en-Y-Gastric bypass – Our experience in Indian patients

Background: The indications for revision bariatric surgery include inadequate weight loss, weight regain, failure to resolve comorbidities, and complications associated with primary surgery. Objectives: The objective is to evaluate the outcome of revision of Roux-en-Y gastric bypass (RYGB) and compare the efficacy of different revision procedures for weight regain, resolution of comorbidities, and complications, if any. Methods: Revision cases performed between May 2017 and April 2021 were included. The analysis of collected data was carried out for weight loss, resolution of comorbidities, and adverse outcomes. Results: Twenty three revision procedures were performed. Two patients were lost to follow-up. The overall complication and reoperation rates were 14.29% and 4.76%, respectively. The follow-up duration was at 6, 12, and 36 months. Twenty-one (91.3%) patients completed 6-month, 18 (78.3%) 12-month, and nine (39.1%) completed 36-month follow-up. The mean postoperative body-mass index at 6, 12, 36 months were 33.07+/−4.15, 33.11+/−4.05, 34.5 ± 8.81, respectively. The mean %excess weight loss (EWL) at 6, 12, 36 months were 39.47+/−13.76, 43.70+/−13.70, 41.14+/−8.48%, respectively. The patients were divided into three groups. Group A - lengthening of biliopancreatic limb (BPL) by 100 cm (n = 6); Group B - placement of ring with a diameter of 7.5 cm in addition to BPL lengthening (n = 12); and Group C - pouch trimming with BPL lengthening by 100 cm (n = 3). %EWL at 6 months was 31.86, 47.69, and 53.49, in Groups A, B, and C, respectively. Similar trends in %EWL were observed in three groups at 12 and 36 months. Conclusion: Revision bariatric surgeries are complex procedures. In our study, banded RYGB with BPL lengthening had better outcomes, though a statistical significance could not be established due to the small sample size and retrospective nature of the study.