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

Abstract

. 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 loss outcomes 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 LD for 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/m 2 of the BMI, and/or a regain of 25% of percentage excess weight loss (%EWL). Results: During the study period from December 2019 to July 2023, 24 patients with WR after previous RYGB were enrolled. Eleven patients had type I LD (group A) while 13 patients had combined LPR and LD (group B). Both procedures had significantly higher %EWL and lower BMI than the preintervention values at one year of follow-up. Combined LPR and LD patients continued to lose weight significantly over the second year with a statistically significant drop in the mean 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 LD patients had no additional significant weight loss at the 2-year follow-up. Combined LPR and LD led to more weight loss which 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-related comorbidity. Conclusion: Patients with combined LPR and type I LD achieved more superior and durable weight loss at a 2-year follow-up compared to type I LD only.