Revision to Malabsorptive Roux-En-Y Gastric Bypass (MRNYGBP) Provides Long-Term (10 Years) Durable Weight Loss in Patients with Failed Anatomically Intact Gastric Restrictive Operations

Background Twenty percent of gastric restrictive operations require revision. Conversion to Proximal Roux-en- Y gastric bypass (PRNYGBP) is associated with weight regain. Forty-one percent of these fail to achieve a body mass index (BMI)<35. Few report follow-up (F/U) or quality of life (QOL) beyond 5 years. We report the long-term effectiveness of MRNYGBP as a revision. Methods Retrospective chart review of patients (1993– 2005) with a failed gastric restrictive operation (S1) at least a year out from revision (S2) to a MRNYGBP: small lesser curve 22±10 (11–55) cm3 pouch, long biliopancreatic limb, 150 cm alimentary limb, 141±24 (102–190) cm common channel. Staple-line disruptions were excluded. Results Thirty-eight (37 F, 1 M) patients aged 46±8 (17– 56) years underwent conversion to a MRYGBP 8±5 (2–23) years after: gastroplasty 25, adjustable gastric band 13 for weight regain (79%), gastroesophageal reflux disease (GERD; 29%), and band problems (24%). S1 provided only 24±25% excess weight loss (EWL; 5.9±6.3 BMI drop) and caused GERD in 32% of patients (p=0.0124). There were no deaths or leaks. BMI dropped from 41.4± 7.8 to 27.3±5.6 (down 20.5±8.3 from S1), 80.1±23.3% EWL (n=32) at year 1 (p<0.0001). This was maintained for 10 years. BMI was 28±4 (21.5–31.9), 75.6±21.1% EWL (57.3–109.6) (n=5) at 10 years. Super obese patients had better 9.95% EWL after S2 (p=0.0359). QOL (5= excellent): 4.5±0.5 (3–5). F/U: 5.1±3.3 (1–13) years with 83.3% F/U 10-year rate. Labs at 3 years (n=10): Alb 3.8± 0.4, Prot 6.8±0.6, Iron 47.6±33.3, VitD 15.1±7.43, PTH 54.5±27.2, B12 620.1±676.5, Hct 34±4.3. Conclusions Revision MRNYGBP provides excellent durable long-term weight loss after failed gastric restrictive operations. Non-compliant patients are at a higher risk for malnutrition, anemia, and osteoporosis.