Reversal of Roux-en-Y Gastric Bypass to Normal Anatomy-Experience of 70 Patients

A limited subset of patients undergoing Roux-en-Y gastric bypass (RYGB) may develop intractable symptoms that ultimately require reversal to normal anatomy. Existing literature on this subject is characterized by small cohort sizes, substantial variation in surgical techniques, and limited follow-up durations. However, this study presents the largest single-center series to date, comprising seventy patients.

A prospective analysis was conducted on clinical data from patients who underwent laparoscopic reversal of Roux-en-Y gastric bypass (RYGB). The study evaluated the indications for the procedure, technical considerations, clinical outcomes, and associated complications. Patients were stratified into two groups based on their primary symptoms: Group 1 (abdominal pain; n = 47) and Group 2 (hypoglycemia, malnutrition, or other symptoms; n = 23).

Seventy patients were included in the study, with a mean follow-up period of 2.4 years. The majority of patients (93%, 65/70) were female, and the mean age was 44 ± 11.45 years. The mean body mass index (BMI) at baseline was 28.7 ± 6.3 kg/m². In Group 1, 85% of patients experienced either complete or partial resolution of symptoms, while in Group 2, 96% achieved complete symptom resolution. Thromboembolic complications occurred in 7.1% of patients, and 13% required reoperation. At 12 months post-reversal, mean weight and BMI had increased by 9.1 kg and 3.2 kg/m², respectively. At the most recent follow-up, the total weight gain (Δkg) was 14.9 kg, and the BMI increase (ΔBMI) was 5.1 kg/m².

Reversal of Roux-en-Y gastric bypass (RYGB) is an effective intervention for patients experiencing chronic complications. Patients with hypoglycemia and malnutrition experienced higher rates of symptom resolution compared to those with abdominal pain or small bowel adhesions. The implementation of pyloroplasty, combined with high-dose subcutaneous anticoagulant therapy, was associated with a reduction in complication rates. Given the expected weight regain following reversal, it is essential for both surgeons and patients to align their expectations with anticipated outcomes.