Reversal of Roux en Y gastric bypass: largest single institution experience

Abstract Background There is a paucity of literature on patients who have undergone reversal of Roux-en-y gastric bypass (RYGB) to normal anatomy. We present the largest single institution experience with reversal of RYGB for serious chronic complications. Objective To describe our experience including indications, outcomes, and complications of RYGB reversal. Setting Academic-affiliated private practice. Methods Retrospective review of 48 patients who underwent laparoscopic reversal of RYGB between 2012 and 2016. Results 96% (n=46) of patients were female, mean age of 48.6 (range, 23-72). Indications for reversal of RYGB included marginal ulcer (n=25, 12 of whom were malnourished, and 17 had coexisting substance abuse), malnutrition alone (n=11), chronic pain and nausea (n=7), and postprandial hyperinsulinemic hypoglycemia (n=5). Overall 30-day complication rate was 29% (n=14) including gastrogastric anastomotic leak (n=5), sepsis (n=5), bleeding requiring transfusion (n=3). Weight gain after surgery increased in all patients especially those patients deemed severely malnourished. All patients reported resolution of symptoms leading to reversal of RYGB, although 58% of patients were lost to follow up at 1 year after surgery. Conclusions Laparoscopic reversal of Roux-en-Y gastric bypass is a complex revisional operation that can be safely performed in a select group of patients with serious complications. The main indications for reversal of RYGB included malnutrition with and without recalcitrant marginal ulcers. Weight gain and resolution of malnutrition occurred soon after reversal of gastric bypass. Because the complication rates are high, reversal should be considered only after all salvage attempts have failed. Reversal to normal anatomy carries high morbidity including sepsis, leaks, and bleeding, high re-operative rates and readmission. While reversal of RYGB has a role in treatment of select group of patients, it should be undertaken by surgeons with a considerable experience in RYGB revision.