Combined laparoscopic pouch and loop resizing as a revisional procedure for weight regain after primary laparoscopic one-anastomosis gastric bypass

摘要

Introduction: One-anastomosis gastric bypass (OAGB) presents a satisfactory long-term outcome in terms of weight loss, amelioration of comorbidities and low morbidity. However, some patients may present insufficient weight loss or weight regain. In this study, we tackle a case series evaluating the efficiency of the combined laparoscopic pouch and loop resizing (LPLR) as a revisional procedure for insufficient weight loss or weight regain after primary laparoscopic OAGB. Materials and Methods: We included eight patients with a body mass index (BMI) >= 30 kg/m(2) with a history of weight regain or insufficient weight loss after laparoscopic OAGB, who underwent revisional laparoscopic intervention by LPLR between January 2018 and October 2020 at our institution. We conducted a 2 years' follow-up. Statistics were performed using International Business Machines Corporation((R)) SPSS (R) software for Windows version 21. Results: The majority of the eight patients were males (62.5), with a mean age of 35.25 at the time of the primary OAGB. The average length of the biliopancreatic limb created during the OAGB and LPLR were 168 +/- 27 and 267 +/- 27 cm, respectively. The mean weight and BMI were 150.25 +/- 40.73 kg and 48.68 +/- 11.74 kg/m(2) at the time of OAGB. After OAGB, patients were able to reach an average lowest weight, BMI and per cent of excess weight loss (EWL) of 89.5 +/- 28.85 kg, 28.78 +/- 7.47 kg/m(2) and 75.07 +/- 21.62, respectively. At the time of LPLR, patients had a mean weight, BMI and EWL of 116.12 +/- 29.03 kg, 37.63 +/- 8.27 kg/m(2) and 41.57 +/- 12.99, respectively. Two years after the revisional intervention, the mean weight, BMI and EWL were 88.25 +/- 21.89 kg, 28.44 +/- 4.82 kg/m(2) and 74.51 +/- 16.54, respectively. Conclusion: Combined pouch and loop resizing is a valid option for revisional surgery following weight regain after primary OAGB, leading to adequate weight loss through enhancement of the restrictive and malabsorptive effect of OAGB.