Laparoscopic Reversal of Gastric Bypass: A Retrospective Review

Gastric bypass can result in serious complications such as dumping syndrome, Malnutrition, and chronic abdominal pain refractory to symptomatic treatment and necessitate surgical intervention in the form of reversal to normal anatomy. Our study draws on a 5-year experience in the reversal of gastric bypass, addressing indications, operative techniques, and complications associated with this procedure.

This retrospective analysis pilot study included ten patients who underwent reversal of either Roux-en-Y gastric bypass (RYGB) or one-anastomosis gastric bypass (OAGB) and investigated their indications, complications, and outcomes.

Ten patients underwent gastric bypass reversal; 60% of them had a reversal of OAGB, while 40% had a reversal of RYGB. The main indications for bypass reversal were malnutrition (hypoalbuminemia) (33%), excessive loss of weight (29%), followed by chronic abdominal pain, chronic anemia, diarrhea, non-healing Marginal ulcer, and persistent reflux, representing 10% each. Follow-up was achieved in 90% of patients at 180 days (6 months), and the overall postoperative morbidity was 10%. Within the 6 months, there was a single mortality event (10%) attributed to preexisting liver cell failure. The mean BMI preoperatively and postoperatively were 26.2 kg/m² and 27.9 kg/m², respectively (p-value = 0.013) at 6 months, while the mean serum albumin levels preoperatively and postoperatively were 2.8 g/dl and 3.4 g/dl, respectively (p-value = 0.019).

Laparoscopic reversal of gastric bypass is a complex surgery requiring a specialized surgical center, and it should be a last resort for intractable chronic symptoms. Patient education about relatively high morbidity and the possibility of dissatisfaction is crucial.