Combined Proximal Revision and Moderate Distalization After Roux-en-Y Gastric Bypass: A Retrospective Single-Center Case Series.

BACKGROUND

Suboptimal initial clinical response (SICR) and recurrent weight gain (RWG) after Roux-en-Y gastric bypass (RYGB) pose significant clinical challenges. More aggressive malabsorptive conversions enhance weight loss but are associated with increased metabolic risk. This study reports single-center descriptive outcomes of a combined revision of RYGB (CR-RYGB), consisting of proximal revision with a moderate type 1 distalization.

METHODS

This retrospective single-center case series includes 163 consecutive patients who underwent CR-RYGB between October 2019 and January 2025. Perioperative characteristics, postoperative morbidity, and longitudinal weight-loss outcomes were descriptively analyzed.

RESULTS

Mean pre-revision BMI was 41.35 kg/m², with a mean follow-up of 14.3 months. Indications were SICR (12.3%), formal RWG (82.2%), and less significant RWG (5.5%). No intraoperative complications or conversions occurred. Proximal revision consisted of gastrojejunal sleeve (87.1%), pouch resizing (5.5%), or redo gastrojejunostomy (7.4%), with additional banding in 45.4%. Mean total alimentary limb length after type 1 distalization was 507cm. Early and late postoperative complication rates were 3.7% and 6.7%, respectively. Two patients required reoperation (one for malnutrition, one for intractable steatorrhea). Mean percentage total weight loss was 20.3% at 12 months, 22.2% at 2 years, 24.5% at 3 years, and 22.2% at 4 years.

CONCLUSION

In this retrospective single-center case series, CR-RYGB had low postoperative morbidity and sustained weight loss during follow-up. These descriptive findings support the hypothesis that CR-RYGB may provide balance between weight loss and metabolic risk compared with more aggressive distalization alone. However, no conclusions regarding comparative safety or efficacy can be drawn, warranting prospective controlled studies.