Indications for combining remnant resection in a primary Roux-N-Y gastric bypass: Preliminary results.

INTRODUCTION

Gastric intestinal metaplasia (GIM) is a precancerous lesion that has been independently associated with gastric cancer development. The presence of GIM in the preoperative study of Roux-n-Y gastric bypass (RYGB) raises question of whether or not remove the gastric remnant (GR) due to the impossibility of endoscopic surveillance.

METHODS

Descriptive analysis of 6 consecutive cases of GR resection in RYGB from 2012 to 2021.

RESULTS

There are six cases (100 ​% women) with an age of 61 (41-63) years and pre-surgical BMI of 40.5(34.8-43.3) Kg/m2. Endoscopy confirmed the presence of GIM in 83.3 ​% of the patients. The surgical time for the RYGB with GR resection was 141 (95-172) minutes. The hospital stay was 2 (2-4) days. No postoperative complications or mortality were observed at 30 days. Histological analysis of GR demonstrates GIM appears in 83.3 ​%. Weight loss results at 12 months of follow-up are equivalent to regular RYGB, BMI of 26.8 (25.9-29.6) Kg/m2.

CONCLUSIONS

GR resection indication in RYGB must be individualized. GIM is an independent risk factor and, given the impossibility of endoscopic surveillance, the addition of GR resection could be considered. It is a procedure that, in expert hands, is safe with the same postoperative results as a regular RYGB. However, larger samples and long-term follow-up are mandatory to confirm these results.