Department of Surgery, University of Missouri, Columbia, MO, USA.
Obes Surg. 2024 Feb;34(2):702-703. doi: 10.1007/s11695-023-07026-y. Epub 2024 Jan 8.
Although uncommon, significant weight recurrence after Roux-en-Y gastric bypass (RYGB) can occur. Options are limited to help patients achieve additional weight loss, and improved techniques for revisional/conversional surgery are needed to achieve optimal outcomes while avoiding significant side effects. Although limited data exist regarding distalization of the Roux limb to achieve a longer biliopancreatic limb leading to some level of malabsorption, we have seen adequate weight loss with minimal significant side effects in patients undergoing this procedure with our approach. An appropriate technical approach to this procedure is important to avoid immediate and long-term complications.
We present a video describing our approach to Roux limb distalization for weight gain after gastric bypass, describing our approach for work-up, operative technical pearls, and postoperative monitoring in these patients. A 61 year-old female who initially had good weight loss after RYGB with a body mass index (BMI) nadir of 33, from a preoperative BMI of 53, experienced weight recurrence with her BMI increasing to 48. After preoperative nutritional optimization, dietary counseling, and behavioral counseling, she underwent conversion of RYGB to distalization of Roux limb to create a distal RYGB. She tolerated the procedure well and was discharged on postoperative day 2. At 1-year follow-up, her BMI had decreased to 37 with improvement in dyslipidemia, elevation of liver transaminases, and improvement in hemoglobin A1C. This reflects the impact of this procedure on not only weight loss but also concurrent metabolic diseases associated with obesity.
We present a case of distalization of a RYGB for weight recurrence, highlighting the technical pearls when performing the procedure. Accurate, intraoperative measurement of the total alimentary limb length is essential to achieve weight loss while minimizing malnutrition and vitamin deficiencies. Assessment of preoperative nutritional levels for evidence of any protein calorie malnutrition is important during surgical decision-making when this conversional metabolic operation is considered. Frequent, postoperative nutritional monitoring is important and occurs with a full bariatric nutritional panel at 3, 6, 9, and 12 months then yearly thereafter. Using our approach, we feel that conversion of RYGB to distalization of Roux limb can lead to improved weight loss without significant side effects.
尽管不常见，但 Roux-en-Y 胃旁路（RYGB）术后仍可能出现明显的体重复发。可供选择的方法有限，无法帮助患者进一步减重，需要改进修正/转换手术技术，以在避免严重副作用的同时实现最佳效果。尽管关于延长 Roux 袢以达到一定程度的吸收不良来实现更长的胆胰支的相关数据有限，但我们采用这种方法对患者进行手术时，看到了足够的减重效果，且副作用很小。为避免术后即刻和长期并发症，采用合适的技术方法非常重要。
我们提供了一段视频，描述了我们对 Roux 袢远端化治疗胃旁路术后体重增加的方法，介绍了我们在这些患者中的术前评估、手术技术要点以及术后监测方法。一位 61 岁女性，最初 RYGB 术后体重减轻，体重指数（BMI）最低降至 33，术前 BMI 为 53，术后体重复发，BMI 增至 48。经过术前营养优化、饮食咨询和行为咨询，她接受了 RYGB 修正术，即 Roux 袢远端化，以创建远端 RYGB。她术后恢复良好，术后第 2 天出院。1 年随访时，她的 BMI 降至 37，血脂异常、肝转氨酶升高及血红蛋白 A1C 改善。这反映了该手术不仅对体重减轻，而且对肥胖相关的合并代谢疾病都有影响。
我们报告了一例 RYGB 远端化治疗体重复发的病例，重点介绍了手术过程中的技术要点。准确测量总肠袢长度对于实现减重、最小化营养不良和维生素缺乏至关重要。在考虑进行这种转换代谢手术时，术前营养水平评估对于是否存在蛋白质热量营养不良很重要。术后营养监测非常重要，术后 3、6、9 和 12 个月及以后每年进行全面减重营养小组检查。我们认为，将 RYGB 转换为 Roux 袢远端化可以在不产生严重副作用的情况下改善减重效果。
