Outcomes of simultaneous endoscopic transoral outlet reduction and gastric bypass distalization for the management of weight loss failure after Roux-en-Y gastric bypass.

Background: There are numerous revisional surgery options for weight loss failure after Roux-en-Y Gastric Bypass. To date, there are no studies that assess the weight loss outcomes of single-stage endoscopic revision of the gastrojejunostomy (GJ) (TORe) in biliopancreatic (BP) limb distalization. We aimed to report our experience with single-stage TORe and distalization.

Methods: Sixteen patients (5 TORe and distalization, 6 TORe alone, 5 distalization alone) from 2021 to 2023 were included and retrospectively reviewed. The minimum follow-up time was 24 months. The alimentary limb was distalized to allow for a total common channel length of about 150 cm and the endoscopic suturing was used to bring the diameter of the GJ between 10 and 20 mm.

Results: The average preoperative BMI was 44.25 ± 8.8 kg/m² with an average excess body weight of 54.16 ± 23.6 kg. The mean operative time for patients who had distalization with and without TORe was 128.4 ± 30.3 min. The mean total alimentary limb length (TALL) was 300 + 45.6 cm. Single-stage TORe and distalization showed higher mean %TWL (23.67 vs 19.92 vs 15.02) and %EWL (37.20 vs 30.72 vs 27) compared to TORe and distalization alone at 24-month follow-up, respectively. One patient required distalization reversal due to malnutrition. The rest of patients who underwent distalization showed minor nutritional deficiencies (Hemoglobin, Hematocrit, Vitamin A, and Copper) at the last follow-up. Preoperative comorbidities were reduced by 33.2%.

Conclusions: Endoscopic and surgical techniques for the management of weight loss failure after Roux-en-Y Gastric Bypass seem to be safe and effective. Single-stage TORe and distalization showed higher weight loss at 24-month follow-up.