Resectional Roux-en-Y Gastric Bypass Versus Standard Roux-en-Y Gastric Bypass: Impact of Concomitant Gastric Remnant Resection on Postoperative Complications and Weight Loss Outcomes in a High-Volume Center.

Abstract

Purpose: Concomitant gastric remnant resection (GRR) during Roux-en-Y gastric bypass (RYGB)-hereafter resectional RYGB (rRYGB)-may be required in selected cases, including premalignant conditions, persistent Helicobacter pylori infection, or revisional surgery, but is associated with increased morbidity. We evaluated the impact of rRYGB on surgical outcomes in a high-volume center.

Materials and methods: A retrospective analysis included patients undergoing primary and revisional RYGB, divided by whether a concomitant GRR was performed (rRYGB) or not (standard RYGB). Intra- and postoperative complications, reintervention, mortality and weight loss were assessed.

Results: Of 2,103 patients, 89 (4.2%) underwent rRYGB. The overall complication rate was higher with rRYGB, without reaching significance (14.6% vs. 8.9%; P=0.067), but was significant in primary RYGB (16.9% vs. 8.7%; P=0.023). rRYGB was associated with higher rates of leak/fistula (2.2% vs. 0.2%; P=0.001), food intolerance (2.2% vs. 0.3%; P=0.003), intra-abdominal collections (2.2% vs. 0.2%; P<0.001), and reintervention (7.9% vs. 3.1%; P=0.013). After adjustment, rRYGB remained independently associated with complications (odds ratio [OR], 2.30, 95% confidence interval [CI], 1.16-4.54) and reintervention (OR, 3.23, 95% CI, 1.31-7.96) in primary RYGB. Ninety-day mortality was zero. Weight loss tended to be greater with rRYGB (2-year total weight loss [TWL], 38.9% vs. 36.0%; excess weight loss, 99.7% vs. 92.0%), reaching significance for TWL in some adjusted analyses.

Conclusion: rRYGB is associated with increased postoperative morbidity, particularly fistula, food intolerance, and intra-abdominal collections. The trend toward greater weight loss was inconsistent across measures and time points and should be regarded as exploratory. Careful patient selection and individualized decision-making are essential.