Background

Standard proximal Roux-en-Y gastric bypass (RYGB) results in inadequate weight loss in up to 35% of cases. Short to intermediate-term studies involving the conversion of standard RYGB to type 1 distal bypass have shown improved and sustained additional weight loss and impact on obesity-related comorbidities, particularly metabolic syndrome. This study aims to assess long-term sustainment of weight loss, comorbidity remission, and nutritional complications of type 1 distalization as a revision of RYGB.

Methods

A retrospective review of all patients who underwent conversion to distal RYGB at a single center from 2010 to 2016 was performed. RYGB was modified by dividing the Roux limb at the jejunojejunostomy and transposing it distally to create a total alimentary limb length of 400 cm.

Results

Ninety-six patients underwent type 1 distalization with an average weight and BMI of 244.0 lbs and 40.57 kg/m2, respectively. At 7 years postoperative, there was a significant decrease in BMI to 34.2 kg/m2 (p= 0.0001, n=33). Additionally, 66.7% and 42.9% of patients achieved remission of diabetes and hyperlipidemia, respectively. There was no significant difference between albumin and protein levels at 7 years postoperative compared to pre-distalization (p= 0.147), suggesting a lack of nutrition deficiencies.

Conclusions

Revision of proximal RYGB to type 1 distalization results in substantial improvement in weight loss, greater remission of comorbidities, and maintenance of nutritional levels long-term.