Feasibility of Small Bowel Length Shortening with Sleeve Gastrectomy for Metabolic and Nutritional Complications After RYGB.

INTRODUCTION

Metabolic and nutritional complications-including intractable dumping syndrome (DS), gastroesophageal reflux disease (GERD), anemia, and weight recurrence-may develop long after Roux-en-Y gastric bypass (RYGB). Current revisional options, such as reversal or distalization, can be technically demanding and may worsen malabsorption. Restoring gastric continuity and pyloric function may offer physiological benefits. This study evaluated the feasibility and early outcomes of small bowel length optimization and shortening with sleeve gastrectomy (BOS-SG) as a revisional strategy after RYGB.

METHODS AND PROCEDURES: This retrospective analysis included 8 consecutive female patients who underwent BOS-SG, with or without hiatal hernia repair, between 2018 and 2023 at a tertiary center. Indications were refractory DS, GERD, anemia unresponsive to medical therapy, and weight recurrence. A standardized multidisciplinary and endoscopic evaluation was performed preoperatively. Perioperative parameters and postoperative clinical outcomes were reviewed.

RESULTS

All procedures were completed laparoscopically without conversion. The mean operative time was 168 minutes, and the mean hospital stay was 5 days. Compared with pre-revision status, patients achieved a mean weight loss of 6.7 kg, corresponding to 7.9% total weight loss and 39.9% excess weight loss. DS resolved in all patients. GERD improved in 60% of symptomatic patients, and 60% of those with anemia normalized hemoglobin. Two patients (25%) required reoperation, 1 for recurrent hiatal hernia, and 1 for an anastomotic leak, both managed laparoscopically with good recovery.

CONCLUSION

BOS-SG appears feasible and may provide physiological advantages through restoration of gastric continuity and pyloric function in selected patients with post-RYGB metabolic or nutritional complications. Larger prospective studies are needed to validate these early findings.