Ryan Fairley, DO1, Moataz Bashah, MD2, Danial Cottam, MD3, Helmuth T Billy1. 1Community Memorial Hospital, Ventura California, 2Hamad Medical Center, Doha Qatar, 3Bariatric Medical Institute, Salt Lake City, Utah
Background: Failed Roux-Y Gastric Bypass (RYGB) is a difficult problem with few options for treatment. We report a series of ten consecutive morbidly obese patients with weight regain following RYGB who were converted to SADI-S using a 2 stage approach.
Methods: 10 patients with a history of laparoscopic RYGB and weight regain (BMI >35) were evaluated for surgical revision. Each patient completed medical weight management consisting of monthly appointments with a dietician, psychological evaluation and follow up with the physician team. All patients failed to achieve any significant weight loss. Each patient underwent laparoscopic reversal of the RYGB as a first stage followed by revision to laparoscopic SADI-S as a second stage.
Results: 10 morbidly obese patients underwent revision following weight regain after RYGB. Average pre-operative BMI was 44.3 with a range of 37.6 to 54.1. All patients underwent EGD without evidence of abnormal pathology. EGD revealed an average gastric pouch length between 5 and 6cm. There was no evidence of pouch dilation, fistula, anastomotic dilation or other abnormality that might have contributed to weight regain. Presenting weight ranged from 210.5 pounds to 362.4 pounds. Each patient underwent laparoscopic reversal of their gastric bypass to normal anatomy. The average time from primary RYGB to reversal of gastric bypass was 8 years. Average operative time to perform the reversal RYGB to normal anatomy was 170.9 minutes. Average length of stay was 2.5 days.
Time between reversal of RYGB to laparoscopic SADI-S ranged from 3 to 6 months. Preoperative weight at the time of SADI-S ranged from 215.5 pounds to 353.8 pounds. Average operating time to perform the laparoscopic SADI-S was 198.3 minutes. Average length of stay was 2.7 days. 30 day post operative weight ranged from 196.6 to 316.6 pounds and the average weight lost per patient in the first 30 days was 19.85 pounds.
In the 30 days following SADI-S, 2 patients were seen in the emergency department for reflux, both treated with proton pump inhibitors not requiring admission. There were no reoperations, there were no deaths and there were no readmissions
Conclusions: Our series of 10 patients undergoing a two stage approach to revise failed RYGB to SADI-S appears to be a promising and safe approach to the challenge of weight regain following RYGB. Further long term follow up and a larger series will be needed to demonstrate safety and efficacy,
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95899
Program Number: P121
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster