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Indications for combining remnant resection in a primary Roux-N-Y gastric bypass: Preliminary results
Clara Pañella1, Carmen Rodríguez-Haro2, María Hernández-O'Reilly2
1Upper Gastrointestinal Unit, Department of General and Digestive Surgery, Joan XXIII University Hospital, Universitat Rovira i Virgili de Tarragona. 4, Dr. Mallafré Guasch, 43005, Tarragona, Spain.
Introduction:
Gastric intestinal metaplasia (GIM) is a precancerous lesion that has been independently associated with gastric cancer development. The presence of GIM in the preoperative study of Roux-n-Y gastric bypass (RYGB) raises question of whether or not remove the gastric remnant (GR) due to the impossibility of endoscopic surveillance.
Methods:
Descriptive analysis of 6 consecutive cases of GR resection in RYGB from 2012 to 2021.
Results:
There are six cases (100 % women) with an age of 61 (41-63) years and pre-surgical BMI of 40.5(34.8-43.3) Kg/m2. Endoscopy confirmed the presence of GIM in 83.3 % of the patients. The surgical time for the RYGB with GR resection was 141 (95-172) minutes. The hospital stay was 2 (2-4) days. No postoperative complications or mortality were observed at 30 days. Histological analysis of GR demonstrates GIM appears in 83.3 %. Weight loss results at 12 months of follow-up are equivalent to regular RYGB, BMI of 26.8 (25.9-29.6) Kg/m2.
Conclusions:
GR resection indication in RYGB must be individualized. GIM is an independent risk factor and, given the impossibility of endoscopic surveillance, the addition of GR resection could be considered. It is a procedure that, in expert hands, is safe with the same postoperative results as a regular RYGB. However, larger samples and long-term follow-up are mandatory to confirm these results.
