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Cited by 104Bariatric Surgery and OutcomesMinimally Invasive Surgical TechniquesEnhanced Recovery After Surgery

Laparoscopic reversal of Roux-en-Y gastric bypass: Technique and utility for treatment of endocrine complications

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Campos, Guilherme M., Ziemelis, Martynas, Paparodis, Rodis, Ahmed, Muhammed, Belt Davis, Dawn·2014·Surgery for Obesity and Related Diseases
DOI 10.1016/j.soard.2013.05.012PMC PMC5947315
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Abstract

Background The anatomic and physiologic changes with Roux-en-Y gastric bypass (RYGB) may lead to uncommon but occasionally difficult to treat complications such as hyperinsulinemic hypoglycemia with neuroglycopenia and recalcitrant hypocalcemia associated to hypoparathyroidism. Medical management of these complications is challenging. Laparoscopic reversal of RYGB anatomy with restoration of pyloric function and duodenal continuity is a potential treatment. The objective of this study was to present the indications, surgical technique, and clinical outcomes of laparoscopic reversal of RYGB. Methods Prospective study of consecutive patients offered laparoscopic reversal of RYGB. Results Five patients with remote laparoscopic RYGB underwent laparoscopic reversal of RYGB to normal anatomy (n = 2) or modified sleeve gastrectomy (n = 3). Indications were medically refractory hyperinsulinemic hypoglycemia with neuroglycopenia (n = 3), recalcitrant hypocalcemia with hypoparathyroidism (n = 1), and both conditions simultaneously (n = 1). Before reversal, all patients had a gastrostomy tube placed in the excluded stomach to document improvement of symptoms. Laparoscopic reversal was accomplished successfully in all patients. Three postoperative complications occurred: bleeding that required transfusion, gallstone pancreatitis, and a superficial trocar site infection. Average length of stay was 3 days. At a mean follow-up of 12 months (range 3 to 22), no additional episodes of neuroglycopenia occurred, average number of hypoglycemic episodes per week decreased from 18.5 ± 12.4 to 1.5 ± 1.9 (P = .05), and hypocalcemia became responsive to oral replacement therapy in both patients. Conclusions Laparoscopic reversal of RYGB to normal anatomy or modified sleeve gastrectomy is feasible and may be a therapeutic option for selected patients with medically refractory hyperinsulinemic hypoglycemia and/or recalcitrant hypocalcemia associated with hypoparathyroidism.

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  • Various surgical re-interventions have been used, including gastric tube placement, gastric bypass reversal with or without concomitant sleeve resection and gastric pouch restriction.

    “Various surgical re-interventions have been used, including gastric tube placement, gastric bypass reversal with or without concomitant sleeve resection and gastric pouch restriction (Table 5) (66,103,105-123).”

    From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [106]

    The Results describe G-tube placement, and the surgical-technique section describes bypass reversal both with and without sleeve gastrectomy. The passages do not describe gastric pouch restriction as a re-intervention, so this source supports only part of the list. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Approximately 24% of patients who underwent surgical re-intervention because of refractory severe post-Roux-en-Y gastric bypass hypoglycemia received a gastric bypass reversal and approximately 9% had gastric pouch restriction.

    “As shown in Table 5, approximately 24% of patients who underwent surgical re-intervention because of refractory severe post-Roux-en-Y gastric bypass hypoglycemia received a gastric bypass reversal (66,103,106-113) and approximately 9% had gastric pouch restriction (66,114,115).”

    From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [106]

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Sorted by citations

Authors
Campos, G. M., Ziemelis, M., Paparodis, R., Ahmed, M., & Belt Davis, D.
Affiliations
University of Wisconsin–Madison (US)
Corresponding author
Campos, Guilherme M.
ORCID
Venue
Surgery for Obesity and Related Diseases
Publisher
Elsevier BV
Published
2014-01
Volume
10
Issue
1
Pages
36-43
ISSN
1550-7289 (ISSN-L)
DOI
10.1016/j.soard.2013.05.012
PMC
PMC5947315
OpenAlex
W2058293677
Cited by
104
References
5
Citations by year
2026: 3 · 2025: 6 · 2024: 6 · 2023: 8 · 2022: 11 · 2021: 4 · 2020: 10 · 2019: 8 · 2018: 8 · 2017: 6 · 2016: 17 · 2015: 9 · 2014: 8
FWCI
10.62
Type
journal article
Language
en
Open access
Licence
Locations
  • Surgery for Obesity and Related Diseases (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (UL1TR000427)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
  • Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
  • Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
Keywords
hyperinsulinemic hypoglycemia
MeSH terms
Adult, Chronic Disease, Endocrine System Diseases, Female, Gastrectomy, Gastrostomy, Humans, Hyperinsulinism, Hyperparathyroidism, Hypocalcemia, Hypoglycemia, Male, Middle Aged, Laparoscopy, Postoperative Care, Postoperative Complications, Reoperation, Retrospective Studies, Gastric Bypass, Treatment Outcome

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