THE GASTRIC BYPASS FOR FAILED BARIATRIC SURGICAL-PROCEDURES

Background: Revision of failed bariatric surgical procedures is a sign ificant challenge for every bariatric surgeon, Methods: Evaluated are surgical difficulties, management problems and weight loss in patients with distal gastric bypass as a revisionary procedure, Eighty patient s were followed up to 3 years; four were lost to follow-up. Mean age w as 43; mean prebariatric surgery weight 134 kg; height 1.65 meters; bo dy mass index 40.1; ideal body weight 62.7 kg; excess weight 70.5 kg; per cent excess weight 214%, A 250 cm stomach-to-ileocecal valve segme nt of small bowel was used, and the biopancreatic secretions were brou ght into the terminal ileum 100 cm from the ileocecal valve. Mean pouc h size was 63 cc; length of hospital stay 5 days; operative blood loss 616 cc; operative time 130 min, Results: Intraoperative complications included three splenic injuries (without splenectomy). Early complica tions included one deep vein thrombosis, two marginal ulcers, one GI h emorrhage, one wound dehiscence, one pouch outlet obstruction and one pancreatitis, Late complications included: one death from protein maln utrition/ARDS; 21 hypoproteinemia; six protein malnutrition, and of th ese, three had hyperalimentation; three cholecystitis; 27 anemia; 22 i ncisional hernia; two staple-line disruption (reoperated); 26 low seru m iron; 11 prolonged (>6 months) diarrhea; three prolonged frequent vo miting; and two unrelated deaths (chronic myelogenous leukemia and amy otrophic lateral sclerosis), Mean excess weight loss was 83% at 12 mon ths; 89% at 24 months; and 94% at 36 months, Conclusion: The distal ga stric bypass is fraught with the operative and immediate post-operativ e complications experienced in any revisionary bariatric surgery. Dist al gastric bypass is very effective in producing long-term weight loss , Nutritional problems are common but usually easily corrected. The mo st serious nutritional complication is protein malnutrition, which mus t be identified and corrected early, Success of this procedure is depe ndent upon patient compliance with proper nutrition and supplements, a nd regular office follow-up with monitoring of laboratory data, Patien ts who are noncompliant are at significant risk for complications.