Roux-en-Y gastric bypass for the treatment of severe complications after omega-loop gastric bypass

• Published in: Surgery for obesity and related diseases Vol. 13; no. 6; pp. 988 - 994
• Main Authors: Poghosyan, Tigran, M.D., Ph.D, Caille, Clementine, M.D, Moszkowicz, David, M.D., Ph.D, Hanachi, Mouna, M.D., Ph.D, Carette, Claire, M.D., Ph.D, Bouillot, Jean-Luc, M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2017
• Subjects: Adult; Anemia - etiology; Anemia - surgery; Digestive System Diseases - etiology; Digestive System Diseases - surgery; Female; Gastric Bypass - adverse effects; Gastric Bypass - methods; Gastroenterology and Hepatology; Humans; Hypoalbuminemia - etiology; Hypoalbuminemia - surgery; Laparoscopy - adverse effects; Malabsorption Syndromes - etiology; Malabsorption Syndromes - surgery; Male; Malnutrition - etiology; Malnutrition - surgery; Nutrition Assessment; Nutritional complication; Omega loop gastric bypass; Postoperative Complications - etiology; Postoperative Complications - surgery; Reoperation - statistics & numerical data; Retrospective Studies; Revisional surgery; Roux-en-Y gastric bypass; Surgery; Surgical complication; Surgical Stapling - statistics & numerical data; Treatment Outcome; Weight Gain - physiology; Weight Loss - physiology; Nutritional complication; Roux-en-Y gastric bypass; Surgical complication; Revisional surgery; Omega loop gastric bypass
• ISSN: 1550-7289; 1878-7533
• DOI: 10.1016/j.soard.2016.12.003

Abstract Background Omega-loop gastric bypass (OLGB) may be associated with severe complications, including anastomotic leak, refractory ulcer or stenosis, undernutrition, and disabling digestive disorders (chronic diarrhea, steatorrhea, bile reflux, and vomiting). OLGB conversion to Roux-en-Y gastric bypass (RYGB) was suggested to treat these complications. Objectives To evaluate the efficacy and risk of severe complications after OLGB conversion to RYGB. Setting University hospital. Methods Retrospective analysis between October 2011 and June 2016. Results Seventeen patients underwent OLGB conversion to RYGB. Fourteen patients (82%) presented at least 1 disabling digestive disorder. Before conversion, 10 patients (58.8%) received nutritional support for undernutrition. There was no postoperative mortality. Seven patients (41.1%) developed major adverse events (<90 d). At conversion, the average weight, body mass index, and percent of excess weight loss for the population without undernutrition (n = 7) were 103.7±24 kg, 38.7±6.8 kg/m², and 37%±33%, respectively. These values were 85±18.3 kg, 30.6±4.7 kg/m², and 73.3%±21.5%, respectively, at 2 years. In patients with undernutrition (n = 10), the average weight, body mass index, and percent of excess weight loss were 52.2±16.5 kg, 18.7±5.9 kg/m², and 149.3%±46.5%, respectively, before nutritional support and 58.9±14.7 kg, 21.1±5.2 kg/m², and 132.7%±39.1%, respectively, at revisional surgery. At 2 years the values were 71±5.6 kg, 24.3±2.2 kg/m², and 104.6%±15.2%, respectively. The patients experienced significant improvements in hypoalbuminemia, anemia, and vitamin/trace element deficiencies. The disabling digestive disorders resolved in 85% of patients. Conclusion The conversion of OLGB to RYGB for severe complications allows for weight correction in patients with undernutrition, reduces disabling digestive disorders, and improves the nutritional status of patients. However, the conversion is associated with high morbidity.