Laparoscopic Wedge Resection of Gastrojejunostomy for Weight Recidivism after Gastric Bypass.

ABSTRACT

BACKGROUND: Weight recidivism after Roux-en-Y gastric bypass (RYGB) is a common problem. Often, this weight loss failure or regain may be due to a wide gastrojejunostomy (GJ). We evaluated the feasibility and safety of a novel approach of laparoscopic wedge resection of gastrojejunostomy (LWGJ) for a wide stoma after RYGB associated with weight recidivism. METHODS: This is a single-center retrospective study of a prospectively collected database. We analyzed outcomes of patients with weight recidivism after RYGB and a documented wide GJ (>2 cm) on imaging, who underwent LWGJ between 11/2013 and 05/2016. RESULTS: Nine patients underwent LWGJ for dilated stomas. All patients were female with a mean ± SD age of 53 ± 7 years. Mean interval between RYGB and LWGJ was 9 ± 3 years. All cases were performed laparoscopically with no conversions. Mean operative time and hospital stay were 86 ± 9 min and 1.2 ± 0.4 days, respectively. The median(IQR) follow-up time was 14(12-18) months. During follow-up, there were no deaths, postoperative complications, or unplanned readmissions or reoperations. The mean and median(IQR) BMI before RYGB and LWGJ were 55.4 ± 8.1 kg/m2 and 56.1(47.9-61.7) and 43.4 ± 8.6 kg/m2 and 42.1(38.3-47.1), respectively. One year after LWGJ, mean and median(IQR) BMI significantly decreased to 34.9 ± 7.3 kg/m2 and 33.3(31.7-35.0) corresponding to a mean %EWL of 64.6 ± 19.9 (P < 0.05). CONCLUSIONS: LWGJ is safe and can lead to further weight loss in patients experiencing weight recidivism after RYGB with a wide GJ (>2 cm). Long-term follow-up is needed to determine the efficacy and durability of LWGJ and compare its outcomes with other endoscopic/surgical approaches for weight recidivism after RYGB with a documented wide GJ.