Background

There are numerous revisional surgery options following inadequate weight loss or weight regain following roux-en-Y gastric bypass. We report our experience with laparoscopic biliopancreatic (BP) limb-lengthening both with and without additional endoscopic revision of the gastrojejunostomy (GJ).

Methods

Thirty-one patients from 2020-2022 were included and retrospectively reviewed. Twelve underwent both laparoscopic and endoscopic revision and seventeen underwent laparoscopic limb-lengthening only. Minimum follow up time was 6 months, with median follow up of 11 months. In all patients the BP limb was lengthened to allow for a total alimentary limb length of about 450 cm. In those that also underwent GJ revision, endoscopic suturing was used to bring the diameter to less than 1 cm.

Results

The average preoperative BMI was 42 with average excess body weight of 102 pounds. The BP limb was lengthened by an average of 137cm (150cm median). In those that underwent laparoscopic limb-lengthening only, the average %EWL was 26.2% with average BMI change of 4.4 and average %TWL of 10.26% at a median follow-up of 11 months. In those that underwent both laparoscopic and endoscopic revision, the average %EWL was 35.4% with average BMI change of 5.5 and average %TWL of 13.7% at a median follow-up of 13 months.

Conclusions

While there is better weight loss with a combined laparoscopic BP limb-lengthening and endoscopic revision of the GJ, there is more that should be considered and studied when treating revisional roux-en-Y gastric bypass patients to maximize weight loss.