Management of weight regain after laparoscopic Roux-en-Y gastric bypass: A retrospective study

Abstract

Background/Objective: Laparoscopic Roux-en-Y gastric bypass (RYGB) is an efficient bariatric procedure. However,weight regain (WR) endangers its outcomes in ~10–20% of patients. In this study, we aim to unravel the weight lossoutcomes of combined Limb distalization (LD) and laparoscopic pouch resizing (LPR) versus LD only.Patients and Methods: We retrospectively followed patients who had either type I LD or combined LPR and type I LDfor WR post-RYGB over a 2-year follow-up period. Patients who had more than one bariatric procedure were excluded.WR is defined as a regain of greater than or equal to 5 kg/m2 of the BMI, and/or a regain of 25% of percentage excessweight loss (%EWL).Results: During the study period from December 2019 to July 2023, 24 patients with WR after previous RYGB wereenrolled. Eleven patients had type I LD (group A) while 13 patients had combined LPR and LD (group B). Both procedureshad significantly higher %EWL and lower BMI than the preintervention values at one year of follow-up. Combined LPRand LD patients continued to lose weight significantly over the second year with a statistically significant drop in themean BMI (from 31.9±6.8 to 28.7±7.1) and a similar rise in the mean %EWL (from 66.1±8.2 to 70.3±6.7), whereas LDpatients had no additional significant weight loss at the 2-year follow-up. Combined LPR and LD led to more weight losswhich is statistically significant at both 1- and 2-year follow-up (P=0.046, P=0.021, respectively). Additionally, 20.8%of our patients developed complications with no mortality recorded. Only one patient had a relapse of obesity-relatedcomorbidity.Conclusion: Patients with combined LPR and type I LD achieved more superior and durable weight loss at a 2-yearfollow-up compared to type I LD only.