Distal small bowel bypass for weight regain after gastric bypass: safety and efficacy threshold occurs at<70% bypass
Abstract
Background For patients with poor weight loss (WL) after Roux-en-Y gastric bypass (RYGB) there are few well-tolerated and effective surgical options. Revision to distal bypass by shortening of the common channel (CC) induces significant WL but often produces protein calorie malnutrition (PCM) and severe diarrhea.Objective The aim of this study was to identify a safe and effective threshold for distal small bowel bypass when done for revision of gastric bypass.Setting Academic Institution, United States.Methods We performed revision of RYGB for WL in 20 patients by shortening the CC to a new length of 120-300 cm. The Roux limb length was unchanged. WL and PCM were monitored. A threshold for percent of small bowel bypassed at which PCM was avoided was retrospectively determined. WL was then compared in patients above and below this threshold. Five patients completed a 250-kcal mixed meal challenge before and 3 months after revision to determine selected gut hormone responses.Results Bypassing ≥70% small bowel resulted in PCM in 4 of 10 patients but in none of 10 patients below that threshold. PCM was observed as late as 2 years after revision and necessitated rerevision by lengthening of the CC in 3 patients. Additionally, nocturnal diarrhea was more common and more intractable when ≥70% bypass was done. Both groups had significant excess body WL over 2 years, but it was greater in patients with ≥70% bypass (47±19 versus 26±17; P<.05). A favorable gut hormone response was observed with 3-hour decrease in glucose-dependent insulinotropic peptide (GIP) by 25% and increase in glucagon-like peptide-1 (GLP-1) by 25%, whereas fasting peptide-YY (PYY) increased by 71% (P<.05 for all).Conclusions Revision of RYGB to distal bypass when it is <70% of a patient's small bowel length results in an acceptable balance of WL and a positive safety profile. WL may be mediated through an enhanced gut hormone effect, an aversion to ingested fat, and possibly other mechanisms.
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Surgical revision to a more distal RYGB induces weight loss and increases postprandial GLP-1 and PYY secretion in those with poor weight loss response.
“Also, surgical revision to a more distal RYGB induces weight loss and increases postprandial GLP-1 and PYY secretion in those with poor weight loss response [127].”
From Bariatric surgery: remission of inflammation, cardiometabolic benefits, and common adverse effects (2020) · cites this paper as [127]
Cites
Roux, C. W. L., Aylwin, S. J. B., Batterham, R. L., Borg, C. M., Coyle, F., Prasad, V., Shurey, S., Ghatei, M. A., Patel, A. G., & Bloom, S. R. (2006) · Annals of Surgery · doi:10.1097/01.sla.0000183349.16877.84 · Cited by 985 · see citing works
Gut hormones as mediators of appetite and weight loss after Roux-en-Y gastric bypass
le Roux, C. W., Welbourn, R., Werling, M., Osborne, A., Kokkinos, A., Laurenius, A., Lönroth, H., Fändriks, L., Ghatei, M. A., Bloom, S. R., et al. (2007) · Annals of Surgery · doi:10.1097/sla.0b013e3180caa3e3 · Cited by 741 · cited 1× · see citing works
“[17] have reported on a small group of 7 patients that the response of these hormones to RYGB is attenuated in poor versus successful WL responders.”
BackgroundHuman duodenal enteroendocrine cells: source of both incretin peptides, GLP-1 and GIP
Theodorakis, M. J., Carlson, O. D., Michopoulos, S., Doyle, M. E., Juhaszova, M., Petraki, K., & Egan, J. M. (2005) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.00326.2004 · Cited by 391 · see citing works
Korner, J., Bessler, M., Inabnet, W., Taveras, C., & Holst, J. J. (2007) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2007.08.004 · Cited by 344 · see citing works
Mechanisms underlying weight loss after bariatric surgery
Miras, A. D., & le Roux, C. W. (2013) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/nrgastro.2013.119 · Cited by 344 · see citing works
Jacobsen, S. H., Olesen, S. C., Dirksen, C., Jørgensen, N. B., Bojsen-Møller, K. N., Kielgast, U., Worm, D., Almdal, T., Naver, L. S., Hvolris, L. E., et al. (2012) · Obesity Surgery · doi:10.1007/s11695-012-0621-4 · Cited by 342 · see citing works
Korner, J., Inabnet, W., Febres, G., Conwell, I. M., McMahon, D. J., Salas, R., Taveras, C., Schrope, B., & Bessler, M. (2009) · International Journal of Obesity · doi:10.1038/ijo.2009.79 · Cited by 338 · see citing works
Conversion of proximal to distal gastric bypass for failed gastric bypass for superobesity
Sugerman, H. J., Kellum, J. M., & DeMaria, E. J. (1997) · Journal of Gastrointestinal Surgery · doi:10.1016/s1091-255x(97)80067-4 · Cited by 276 · see citing works
Gastric bypass revision: lessons learned from 920 cases.
Schwartz, R. W., Strodel, W. E., Simpson, W. G., & Griffen, W. O. (1988) · PubMed · Cited by 177 · see citing works
Melton, G. B., Steele, K. E., Schweitzer, M. A., Lidor, A. O., & Magnuson, T. H. (2008) · Journal of Gastrointestinal Surgery · doi:10.1007/s11605-007-0427-1 · Cited by 175 · see citing works
Factors associated with weight loss after gastric bypass
Campos, G. M. (2008) · Archives of Surgery · doi:10.1001/archsurg.143.9.877 · Cited by 172 · see citing works
Revision of Failed Gastric Bypass to Distal Roux-en-Y Gastric Bypass: A Review of 65 Cases
Fobi, M., Lee, H., Igwe, D., James, E., Stanczyk, M., Eyong, P., Felahy, B., & Tambi, J. (2001) · Obesity Surgery · doi:10.1381/096089201321577866 · Cited by 156 · see citing works
Revisional Bariatric Surgery for Unsuccessful Weight Loss and Complications
Shimizu, H., Annaberdyev, S., Motamarry, I., Kroh, M., Schauer, P. R., & Brethauer, S. A. (2013) · Obesity Surgery · doi:10.1007/s11695-013-1012-1 · Cited by 138 · see citing works
Yimcharoen, P., Heneghan, H., Singh, M. K., Brethauer, S. A., Schauer, P. R., Rogula, T. G., Kroh, M., & Chand, B. (2011) · Surgical Endoscopy · doi:10.1007/s00464-011-1723-0 · Cited by 136 · see citing works
Revision of Roux-en-Y gastric bypass to distal bypass for failed weight loss
Rawlins, M. L., Teel, D. D., Hedgcorth, K., & Maguire, J. P. (2010) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2010.08.013 · Cited by 116 · see citing works
Adding malabsorption for weight loss failure after gastric bypass
Brolin, R. E., & Cody, R. P. (2007) · Surgical Endoscopy · doi:10.1007/s00464-007-9542-z · Cited by 106 · see citing works
Effect of Weight Loss by Diet or Gastric Bypass Surgery on Peptide YY3–36 Levels
Oliván, B., Teixeira, J. A., Bose, M., Bawa, B., Chang, T. C., Summe, H., Lee, H., & Laferrère, B. (2009) · Annals of Surgery · doi:10.1097/sla.0b013e3181a6cdb0 · Cited by 104 · see citing works
Ganiats, T. G., Norcross, W. A., Halverson, A. L., Burford, P. A., & Palinkas, L. A. (1994) · PubMed · Cited by 61 · see citing works
Buchwald, H., Dorman, R. B., Rasmus, N. F., Michalek, V. N., Landvik, N. M., & Ikramuddin, S. (2014) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2014.01.032 · Cited by 59 · see citing works
Moon, R. C., Teixeira, A. F., & Jawad, M. A. (2014) · Obesity Surgery · doi:10.1007/s11695-014-1188-z · Cited by 25 · see citing works
Frequency distribution of weight loss percentage after gastric bypass and adjustable gastric banding
Bessler, M., Daud, A., Digiorgi, M. F., Schrope, B., Inabnet, W. B., & Davis, D. G. (2008) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2008.05.010 · Cited by 24 · see citing works
Flagged first, then by citations
1 of the 22 references couldn’t be matched to a known paper.
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Weight regain after gastric bypass: etiology and treatment options
Maleckas, A., Gudaitytė, R., Petereit, R., Venclauskas, L., & Veličkienė, D. (2016) · Gland Surgery · doi:10.21037/gs.2016.12.02 · Cited by 109 · see citing works
Contribution of Malabsorption to Weight Loss After Roux-en-Y Gastric Bypass: a Systematic Review
Mahawar, K. K., & Sharples, A. J. (2017) · Obesity Surgery · doi:10.1007/s11695-017-2762-y · Cited by 91 · see citing works
Alkhalifah, N., Lee, W., Hai, T., Ser, K., Chen, J., & Wu, C. (2018) · Surgical Endoscopy · doi:10.1007/s00464-017-6011-1 · Cited by 81 · see citing works
Rheinwalt, K. P., Plamper, A., Rückbeil, M. V., Kroh, A., Neumann, U. P., & Ulmer, T. F. (2019) · Obesity Surgery · doi:10.1007/s11695-019-04250-3 · Cited by 78 · see citing works
Bariatric surgery: remission of inflammation, cardiometabolic benefits, and common adverse effects
Biobaku, F., Ghanim, H., Monte, S. V., Caruana, J. A., & Dandona, P. (2020) · Journal of the Endocrine Society · doi:10.1210/jendso/bvaa049 · Cited by 68 · see citing works
Mid-term outcomes of gastric bypass weight loss failure to duodenal switch
Surve, A., Zaveri, H., Cottam, D. R., Belnap, L. P., Medlin, W., & Cottam, A. (2016) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2016.03.021 · Cited by 49 · see citing works
Soong, T., Almalki, O. M., Lee, W., Ser, K., Chen, J., Wu, C., & Chen, S. (2019) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2019.08.010 · Cited by 49 · see citing works
Kraljević, M., Köstler, T., Süsstrunk, J., Lazaridis, I. I., Taheri, A., Zingg, U., & Delko, T. (2019) · Obesity Surgery · doi:10.1007/s11695-019-04348-8 · Cited by 46 · see citing works
Felsenreich, D. M., Langer, F. B., Eichelter, J., Jedamzik, J., Gensthaler, L., Nixdorf, L., Gachabayov, M., Rojas, A. E., Vock, N., Zach, M. L., et al. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10040674 · Cited by 45 · see citing works
Almalki, O. M., Lee, W., Chong, K., Ser, K., Lee, Y.-C., & Chen, S. (2018) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2017.12.022 · Cited by 45 · see citing works
Stomach Intestinal Pylorus-Sparing Surgery for Morbid Obesity
Neichoy, B. T., Schniederjan, B., Cottam, D. R., Surve, A., Zaveri, H., Cottam, A., & Cottam, S. (2018) · JSLS Journal of the Society of Laparoscopic & Robotic Surgeons · doi:10.4293/jsls.2017.00063 · Cited by 40 · see citing works
Aleassa, E. M., Papasavas, P. K., Augustin, T., Khorgami, Z., Benson‐Davies, S., Ghiassi, S., Carter, J. T., & Nimeri, A. A. (2023) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2023.04.298 · Cited by 34 · see citing works
Mirkin, K. A., Alli, V. V., & Rogers, A. M. (2021) · Surgical Clinics of North America · doi:10.1016/j.suc.2020.12.008 · Cited by 32 · see citing works
Surgical therapy of weight regain after Roux-en-Y gastric bypass
Felsenreich, D. M., Langer, F. B., Bichler, C., Kristo, I., Jedamzik, J., Eilenberg, M., Arnoldner, M. A., & Prager, G. (2019) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2019.07.002 · Cited by 26 · see citing works
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Vahibe, A., Aizpuru, M. J., Sarr, M. G., Mundi, M. S., Vierkant, R. A., McKenzie, T. J., Dayyeh, B. K. A., & Ghanem, O. M. (2022) · Journal of the American College of Surgeons · doi:10.1097/xcs.0000000000000397 · Cited by 24 · see citing works
Tourky, M. S., Issa, M., Salman, M. A., Salman, A., Shaaban, H. E., Safina, A., Elias, A. A.-K., Elewa, A., Noureldin, K., Mahmoud, A. A., et al. (2022) · Cureus · doi:10.7759/cureus.21114 · Cited by 23 · see citing works
Hamed, H., Ali, M. S., & Elmahdy, Y. (2020) · Annals of Surgery · doi:10.1097/sla.0000000000004485 · Cited by 21 · see citing works
Pal, A., Rhoads, D. B., & Tavakkoli, A. (2017) · American Journal of Physiology-Gastrointestinal and Liver Physiology · doi:10.1152/ajpgi.00276.2017 · Cited by 14 · see citing works
Nimeri, A. A. (2017) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2017.01.001 · Cited by 11 · see citing works
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Lee, M.-H., Almalki, O. M., Lee, W., Soong, T., & Chen, S. (2022) · Asian Journal of Surgery · doi:10.1016/j.asjsur.2022.07.003 · Cited by 9 · see citing works
Hort, A., Cheng, Q., Morosin, T., Yoon, P. D., & Talbot, M. L. (2022) · ANZ Journal of Surgery · doi:10.1111/ans.18192 · Cited by 9 · see citing works
Bastos, E. L. D. S., Salgado, W., Dantas, A. C. B., Onzi, T. R., Silva, L. B., Albano, A., Tristão, L. S., dos Santos, C. L., Bernardo, W. M., & Silvinato, A. (2024) · Obesity Surgery · doi:10.1007/s11695-024-07206-4 · Cited by 9 · see citing works
Ren, Q., Duan, J., & Cao, J. (2018) · Obesity Surgery · doi:10.1007/s11695-018-3122-2 · Cited by 7 · see citing works
Chaux, F., Bolaños, E., & Varela, J. E. (2015) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2015.08.511 · Cited by 5 · see citing works
Shortening of the Common Channel as a Rescue Surgery After Gastric Bypass Failure
Ortega, J., Kraus-Fischer, G., Ballester, R., & Fernández, N. C. (2020) · Obesity Surgery · doi:10.1007/s11695-020-04854-0 · Cited by 5 · see citing works
Cao, J., Ren, Q., Tan, C. N., & Duan, J. (2017) · Obesity Surgery · doi:10.1007/s11695-017-2571-3 · Cited by 5 · see citing works
Luca, M. D., Piatto, G., Sartori, A., Zese, M., Lunardi, C., Targa, S., Giardiello, C., Gentileschi, P., & HIMPENS, J. M. (2022) · Obesity Surgery · doi:10.1007/s11695-022-06174-x · Cited by 3 · see citing works
A rodent model of partial intestinal diversion: a novel metabolic operation
Alvarez, R., Sandoval, D. A., & Seeley, R. J. (2019) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2019.10.026 · Cited by 3 · see citing works
Papadia, F. S., Karcz, K. W., Pasta, A., & Giannini, E. (2026) · European Journal of Clinical Investigation · doi:10.1111/eci.70234 · Cited by 1 · see citing works
Weight Regain After Bariatric Metabolic Surgery
Bhandari, M., Khurana, M., & Fobi, M. A. L. (2021) · Springer eBooks · doi:10.1007/978-981-33-4702-1_21 · Cited by 1 · see citing works
RYGB Revision and Conversion to Other Procedures
Tassinari, D., Mancini, R., Bellini, R., Berta, R. D., Moretto, C., Sawilah, A. A., & Anselmino, M. (2016) · Updates in surgery/Updates in surgery series · doi:10.1007/978-88-470-3944-5_16 · Cited by 1 · see citing works
Protein deficiency after gastric bypass: the role of common limb length in revision surgery
Kassir, R., & Nunziante, M. (2019) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2019.05.015 · Cited by 1 · see citing works
The Ideal Length of Jejunal Limb in MGB
Rheinwalt, K. P., & Plamper, A. (2018) · Springer eBooks · doi:10.1007/978-3-319-76177-0_5
Metabolic and bariatric surgery: an update from 2010
Nasri, B., Lim, R. B., Ellsmere, J. C., Fernandes, A. R., & Jones, D. B. (2024) · Current Problems in Surgery · doi:10.1016/j.cpsurg.2024.101549
Weight Recurrence and Metabolic and Bariatric Surgery: Definition, Evaluation, and Implications
Jalloh, K., & Altieri, M. S. (2024) · Springer eBooks · doi:10.1007/978-3-031-72309-4_38
de León‐Ballesteros, G. P., Pouwels, S., Ghanem, O. M., Arana-Garza, S., Rodriguez, C., Aceves, M., Angrisani, L., Berry, M. A., Brown, W., Caiazzo, R. J., et al. (2026) · Research Square · doi:10.21203/rs.3.rs-9765725/v1
- Authors
- Caruana, J. A., Monte, S. V., Jacobs, D. M., Voytovich, C., Ghanim, H., & Dandona, P.
- Affiliations
- University at Buffalo, State University of New York (US)
- Corresponding author
- Caruana, Joseph A.
- Venue
- Surgery for Obesity and Related Diseases
- Publisher
- Elsevier BV
- Published
- 2015-11
- Volume
- 11
- Issue
- 6
- Pages
- 1248-1255
- ISSN
- 1550-7289 (ISSN-L)
- OpenAlex
- W1108363959
- Cited by
- 37
- References
- 22
- Citations by year
- 2026: 2 · 2024: 3 · 2023: 1 · 2022: 5 · 2021: 3 · 2020: 4 · 2019: 6 · 2018: 5 · 2017: 4 · 2016: 3 · 2015: 1
- FWCI
- 4.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Surgery for Obesity and Related Diseases (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Keywords
- Roux-en-Y gastric bypass revision
- MeSH terms
- Adult, Anastomosis, Surgical, Female, Follow-Up Studies, Humans, Intestine, Small, Male, Obesity, Morbid, Reoperation, Retrospective Studies, Time Factors, Gastric Bypass, Weight Gain
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