Outcomes Following Gastric Bypass Reversal for Refractory Complications: A UK Tertiary Centre Retrospective Case...

Gastric bypass is an effective and safe metabolic bariatric surgery, yet patients develop refractory long-term complications, post-bypass problems that persisted despite appropriate medical, endoscopic and/or surgical treatment, and that resulted in ongoing symptom burden and nutritional compromise, prompting consideration of reversal. Outcomes following reversal remain poorly characterised. The aim of this study is to describe indications, operative techniques and short- to medium-term nutritional and symptomatic outcomes following gastric bypass reversal in a UK tertiary bariatric centre.

Performed a retrospective analysis of patients undergoing, or referred after, gastric bypass reversal at a UK tertiary bariatric centre (2019-2026). Eight cases were identified. Data included demographics, pre-reversal complications, nutritional status, operative approach, and post-reversal symptomatic and nutritional outcomes. Postoperative follow-up ranged from 1 to 24 months, with a median duration of 17 months (IQR 6-24).

The cohort was predominantly female (n = 5) with a median age of 41 years (IQR 38-46.5). Index procedures included Roux-en-Y (n = 5), one-anastomosis (n = 2), and jejunoileal bypass (n = 1). Reversals were laparoscopic (n = 5) or open (n = 2), with one patient referred to our service post-reversal. Median time to reversal was 4.5 years (IQR 2.5-6.5), during which patients underwent conservative medical management and a mean of two further interventions, including endoscopic balloon dilatations, internal hernia repairs, ulcer perforation repairs and revisional procedures. The dominant indications were a combination of: gastrojejunal complications refractory to conservative management; anatomical complications such as internal hernias; and dumping syndrome, associated with high symptom burden, severe weight loss, and/or moderate hypoalbuminemia. Median pre-reversal BMI and albumin were 21 kg/m² (IQR 17.3-27) and 30 g/L (IQR 30-39). Post-reversal complications included anastomotic leak, ulcers, and incisional hernias. Symptom resolution was inconsistent; patients reported persistent abdominal pain (7 of 8), reflux (4 of 5), dysphagia (4 of 7), poor oral intake (3 of 7), and vomiting (3 of 8). Following reversal, BMI increased to 29 kg/m² (IQR 23.1-33), and albumin to 38 g/L (IQR 32-41).

In this case series, gastric bypass reversal was associated with improved nutritional parameters but with inconsistent symptom relief. Repeated pre-reversal interventions suggest possible delays in making a definitive decision. These findings should be interpreted with caution, given the retrospective design and the small sample size; larger prospective multicentre studies are needed to refine patient selection, timing, and technical strategies for reversals.