Addressing recurrent weight gain after Roux-en-Y gastric bypass: efficacy of a dual surgical approach—short-term results of a single-center cohort study

Background: There is no gold standard for recurrent weight gain following Roux-en-Y gastric bypass (RYGB). Combining jejuno-jejunostomy distalization type 1 (JJD1) and sleeve resection of the gastrojejunostomy and gastric pouch (GJ-P) may be a potential approach for these patients. Objectives: To describe 1-year perioperative and nutritional outcomes of patients who underwent JJD1 with sleeve resection of the GJ-P. Setting: High-volume academic bariatric center of excellence. Methods: Patients with recurrent weight gain after RYGB who underwent JJD1 with sleeve resection of the GJ-P from 2020 to 2022 were included and studied for 1 year postoperatively. During the procedure, we aimed for a total alimentary limb length (TALL) of 350–500 cm, a new common channel (CC) of 200–350 cm, and a gastrojejunostomy <2 cm in diameter. Results: A total of 61 patients underwent this combined revisional procedure. The median preoperative body mass index (BMI) was 42.59 kg/m². The median lengths of the biliopancreatic limb (BPL) before and after distalizatiovn were 50 cm (interquartile range [IQR]: 42.5–75) and 175 cm (IQR: 150–200), respectively. After revision, the median new CC was 270 cm (IQR: 250–300) and the median TALL was 400 cm (interquartile range [IQR]: 362.5–450). The median total small bowel length (TSBL) was 580 cm (IQR 550–640 cm), and the median BPL/TSBL ratio was .32 (IQR .29–.34). At 1, 6, and 12 months, the median BMI of the cohort was reduced to 39.14, 35.55, and 32.9 kg/m², respectively. At 1 year, the total weight loss (%TWL) was 22.18%. Only 3 (n = 3) patients developed major complications at 1 year. After distalization, the resolution of all obesity-related co-morbidities improved, including type 2 diabetes (3.2%), sleep apnea (13.1%), hypertension (HTN) (11.4%), and hyperlipidemia (HLD) (1.6%). Conclusions: The combination of JJD1 and sleeve resection of the GJ-P for RYGB revision was safe and effective, with substantial improvement in weight loss at 1 year.