Enas Al Alawi*

Laparoscopic and Bariatric Surgeon, Algarhoud Private Hospital, Unites Arab Emirates

*Corresponding Author: Enas Al Alawi, Laparoscopic and Bariatric Surgeon, Algarhoud Private Hospital, Unites Arab Emirates.

Received: December 05, 2023; Published: December 27, 2023

Abstract

Background and Objective: Laparoscopic omega-loop bypass (OLB) is a well-accepted bariatric surgical procedure to combat severe obesity and its related co morbidities. Reversal of OLB (ROLB) to normal anatomy is a potential treatment of rare but severe post OLB complications. This study is the first of its kind to be conducted in the UAE addressing the ROLB experience, strengthening the available literature on indications, technique and outcomes.

Methods: Retrospective chart review of all patients who underwent laparoscopic ROLB from January 2014 to December 2017 at the Al Garhoud Private Hospital in Dubai, UAE was done. Age, gender, weight, body mass index (BMI), biochemical parameters, indications for reversal, and post ROLB complications were reviewed.

Results: A total of 16 patients underwent laparoscopic ROLB to normal anatomy. 62.5% of patients were females, age was 34.38 ± 7.55 years (range, 23-56), and pre-reversal BMI was 24.63 ± 3.74 kg/m2 (range 18-34). The indications for reversal were debilitating nausea and early satiety (n = 11), severe and frequent steatorrhea (n = 3), anastomotic ulcer (n = 2) and Bile reflux with excessive weight lose (n = 1). The mean period of follow-up post ROLB was 27.75 ± 15.31 months (range 6 to 48). The mean BMI recorded at last follow up post reversal was 29.89 ± 2.83 kg/m2 (range, 23.34-34.04) which represented an average cumulative weight gain of 13.81 ± 4.79 kgs from their reversal baseline (63.43 ± 11.09 kgs; p = 0.000), while weight loss of 30.69 ± 13.03 kgs from their index OLB baseline (107.94 ± 15.28 kgs; p = 0.000). Mean length of hospital stay following reversal was 2.0 days (range, 1-3). Of 16 patients, only one patient had persistent nausea post reversal which recovered completely after psychological counseling.

Conclusion: Laparoscopic ROLB to normal anatomy is feasible and safe therapeutic option for patients with intractable complications post OLB.

Keywords: Body Mass Index; Obesity; Anatomy

References

1. Buchwald H and Oien DM. “Metabolic/bariatric surgery worldwide 2011”. Obesity Surgery4 (2013): 427-436.
2. Angrisani L., et al. “Bariatric Surgery Worldwide 2013”. Obesity Surgery10 (2015): 1822-1832.
3. Georgiadou D., et al. “Efficacy and safety of laparoscopic mini gastric bypass. A systematic review”. Surgery for Obesity and Related Diseases5 (2014): 984-991.
4. Parmar CD., et al. “Mini Gastric Bypass: first report of 125 consecutive cases from United Kingdom”. Clinical Obesity1 (2016): 61-67.
5. Campos GM., et al. “Laparoscopic reversal of Roux-en-Y gastric bypass: technique and utility for treatment of endocrine complications”. Surgery for Obesity and Related Diseases 1 (2014): 36-43.
6. Kostecka M and Bojanowska M. “Problems in bariatric patient care - challenges for dieticians”. Wideochir Inne Tech Maloinwazyjne3 (2017): 207-215.
7. Park JY and Kim YJ. “Successful laparoscopic reversal of gastric bypass in a patient with malnutrition”. Annals of Surgical Treatment and Research 4 (2014): 217-221.
8. Dapri G., et al. “Laparoscopic reconversion of Roux-en-Y gastric bypass to original anatomy: technique and preliminary outcomes”. Obesity Surgery8 (2011): 1289-1295.
9. Genser L., et al. “Laparoscopic reversal of mini-gastric bypass to original anatomy for severe postoperative malnutrition”. Langenbeck's Archives of Surgery8 (2017): 1263-1270.
10. Rutledge R and Walsh TR. “Continued excellent results with the mini-gastric bypass: six-year study in 2,410 patients”. Obesity Surgery9 (2005): 1304-1308.
11. Himpens J., et al. “Outcomes of revisional procedures for insufficient weight loss or weight regain after Roux-en-Y gastric bypass”. Obesity Surgery11 (2012): 1746-1754.
12. Lee W-J., et al. “Laparoscopic Roux-en-Y Versus Mini-Gastric Bypass for the Treatment of Morbid Obesity”. Annals of Surgery1 (2005): 20-28.
13. Noun R., et al. “One thousand consecutive mini-gastric bypass: short- and long-term outcome”. Obesity Surgery5 (2012): 697-703.
14. Mahawar KK., et al. “Impact of biliopancreatic limb length on severe protein-calorie malnutrition requiring revisional surgery after one anastomosis (mini) gastric bypass”. Journal of Minimal Access Surgery 1 (2018): 37-43.
15. Isreb S., et al. “Laparoscopic instruments marking improve length measurement precision” (2009).
16. Reche F., et al. “Totally Robotic Reversal of Omega-Loop Gastric Bypass to Normal Anatomy”. Obesity Surgery8 (2016): 1994-1995.
17. Brethauer SA., et al. “Systematic review on reoperative bariatric surgery: American Society for Metabolic and Bariatric Surgery Revision Task Force”. Surgery for Obesity and Related Diseases 5 (2014): 952-972.
18. Himpens J., et al. “Laparoscopic conversion of the gastric bypass into a normal anatomy”. Obesity Surgery7 (2007): 908-912.
19. Simper SC., et al. “Laparoscopic reversal of gastric bypass with sleeve gastrectomy for treatment of recurrent retrograde intussusception and Roux stasis syndrome”. Surgery for Obesity and Related Diseases 6 (2010): 684-648.
20. Moon RC., et al. “Indications and outcomes of reversal of Roux-en-Y gastric bypass”. Surgery for Obesity and Related Diseases 4 (2015): 821-826.
21. Akusoba I and El Chaar M. “Laparoscopic Roux-en-Y gastric bypass reversal”. Surgery for Obesity and Related Diseases 2 (2016): 441-442.
22. Pernar LI., et al. “Gastric bypass reversal: a 7-year experience”. Surgery for Obesity and Related Diseases8 (2016): 1492-1498.
23. Sawaya RA., et al. “Vitamin, mineral, and drug absorption following bariatric surgery”. Current Drug Metabolism9 (2012): 1345-1355.
24. Vats MG., et al. “Obesity and Sleep-Related Breathing Disorders in Middle East and UAE”. Canadian Respiratory Journal (2016).
25. Sulaiman N., et al. “Prevalence of overweight and obesity in United Arab Emirates Expatriates: the UAE National Diabetes and Lifestyle Study”. Diabetology and Metabolic Syndrome1 (2017): 88.
26. Brolin RE and Asad M. “Rationale for reversal of failed bariatric operation”. Surgery for Obesity and Related Diseases 5 (2009): 673-677.
27. Gagner M., et al. “Laparoscopic reoperative bariatric surgery: experience from 27 consecutive patients”. Obesity Surgery 12 (2002): 254-260.
28. Arman GA., et al. “Medium-Term Outcomes after Reversal of Roux-en-Y Gastric Bypass”. Obesity Surgery3 (2018): 781-790.
29. Dindo D., et al. “Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey”. Annals of Surgery 240 (2004): 205-213.
30. Mahawar K., et al. “Current status of mini-gastric bypass”. Journal of Minimal Access Surgery4 (2016): 305-310.
31. Carbajo M., et al. “One-anastomosis gastric bypass by laparoscopy: Results of the first 209 patients”. Obesity Surgery 15 (2005): 398-404.
32. Lee WJ., et al. “Laparoscopic Roux-en-Y vs. mini-gastric bypass for the treatment of morbid obesity: A 10-year experience”. Obesity Surgery 22 (2012): 1827-1834.
33. Masheb RM., et al. “The prognostic significance of depressive symptoms for predicting quality of life 12 months after gastric bypass”. Comp Psych3 (2007): 231-236.
34. Wadden TA., et al. “Psychosocial aspects of obesity and obesity surgery”. Obesity Surgery5 (2001): 1001-1024.
35. Kalarchian MA and Marcus MD. “Bariatric surgery and psychopathology”. In: Mitchell JE, de Zwaan (eds). Bariatric Surgery. A Guide for Mental Health Professionals. New York, NY: Routledge Publishing (2005): 59-76.
36. Madhok BM., et al. “Haematological indices and haematinic levels after mini gastric bypass: a matched comparison with Roux-en-Y gastric bypass”. Clinical Obesity1 (2008): 43-49.

Citation

Citation: Enas Al Alawi. “Feasibility, Safety and Operative Outcomes of Omega Loop Bypass Reversal".Acta Scientific Gastrointestinal Disorders 7.1 (2024): 46-62.

Copyright

Copyright: © 2024 Enas Al Alawi. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.