Gastrojejunostomy revision combined with biliopancreatic limb lengthening provides superior weight loss and metabolic outcomes compared to gastrojejunostomy revision alone in Roux-en-Y gastric bypass patients with weight recurrence.

Introduction: The Roux-en-Y gastric bypass (RNYGB) is an effective bariatric surgical procedure for weight loss. Some patients experience weight recurrence or fail to lose weight after a RNYGB. No consensus exists on a recommended revisional procedure for RNYGB patients with weight recurrence.

Methods: We carried out a retrospective review of records from 2010 to 2024, examining patients who had a prior RNYGB, requiring revision for weight recurrence. We compared patients who had revision of the gastrojejunal (GJ) anastomosis alone, to patients who had revision of the gastrojejunal anastomosis and lengthening of the biliopancreatic (BP) limb (GJ + BPLL). We compared demographics, weight outcomes, as well as postoperative complications.

Results: Fifty-one RNYGB patients had a revision primarily for weight recurrence. Twenty-three patients had a GJ revision alone, while 28 patients had a GJ + BPLL. At 24 months post-revision, the GJ + BPLL group had a significantly lower median weight (lbs.) (GJ vs. GJ + BPLL; 288 vs. 186, p = 0.003), as well as BMI (GJ vs. GJ + BPLL; 45.1 vs. 31.91, p = 0.024). Post-revision HbA1c levels were also significantly lower in the GJ + BPLL group (GJ vs. GJ + BPLL; 5.4 vs. 5, p = 0.035). The GJ + BPLL group had a higher rate of multiple vitamin deficiencies. There was no difference between the groups beyond 36 months.

Conclusion: In patients with weight recidivism after a primary RNYGB, GJ + BPLL can achieve greater reduction in weight and BMI with comparable complication rates compared to GJ revision alone, with a clear advantage in HbA1c reduction. While the weight loss outcomes appear to equalize between groups after 36 months, no patients with GJ + BPLL returned to their pre-revision weight. Larger studies are needed to evaluate differences in durability of GJ + BPLL, as well as other long-term outcomes.