[Conversional and endoscopic procedures following bariatric surgery]

Area of Science:

• Bariatric Surgery
• Gastroenterology
• Minimally Invasive Surgery

Background:

• Roux-en-Y gastric bypass (RYGB) is the primary bariatric surgery, but sleeve gastrectomy and gastric banding have higher failure rates.
• Gastroesophageal reflux disease (GERD) can be refractory to medication, necessitating surgical revision.
• Treatment failure after RYGB occurs in up to 20% of cases, requiring revisional interventions.

Purpose of the Study:

• To review revisional procedures for bariatric surgery failures.
• To discuss endoscopic and laparoscopic options for managing RYGB complications.
• To highlight the importance of non-invasive approaches before considering revisional surgery.

Main Methods:

• Endoscopic transoral outlet reduction for gastrojejunal anastomosis revision.
• Laparoscopic revision of enlarged gastric sleeves using full-thickness sutures.
• Laparoscopic approach (Branco-Zorron) for severe hypoglycemic episodes post-RYGB.

Main Results:

• Endoscopic procedures effectively revise bariatric procedures, including RYGB.
• Sleeve diameter reduction and management of hypoglycemia are achievable through specific surgical techniques.
• Revisional surgery can ensure body weight reduction and prevent hypoglycemic episodes.

Conclusions:

• Laparoscopic conversion to RYGB is a viable option for specific cases of treatment failure or GERD.
• Endoscopic and laparoscopic revisional procedures offer solutions for RYGB therapy failure.
• Non-invasive methods should be exhausted before pursuing revisional bariatric surgery.