Revision Options after Gastric Bypass/RYGB

Surgeons have been performing the Roux-gastric bypass even longer than the sleeve gastrectomy.  The Roux-En-Y gastric bypass was the “first” bariatric surgery, and we have been performing the surgery for over 50 years.

As we have a better understanding of metabolism and improved surgical tools, the procedure itself and how we perform it has greatly changed.   For someone who had a Roux-en-y gastric bypass performed in the 1990s or early 2000s, the amount of small intestine bypassed is typically less than the amount of small intestine bypassed today in a more modern Roux-en-Y Gastric Bypass. 

The most effective revisional surgery options after RYGB involve increasing the amount of the small intestine bypassed.  This makes the original RYGB a more powerful metabolic surgery. 

There are two ways to increase the amount of small intestine bypassed after an RYGB.  One method is called a distalization of a RYGB, or a revision to a distal RYGB.  This procedure involves separating the Roux limb, or the food limb, of the original bypass and reconnecting it further downstream on the small intestine.  The Roux/food limb is reconnected to a part on the small intestine that leaves about 300 cm of intestine available to absorb calories.  As mentioned in prior blog posts, 300 cm of small intestine is long enough to absorb the required vitamins and nutrients, but also short enough to result in effective weight loss and cause fat malabsorption.

The other option to bypass more small intestines after an RYGB is to convert the RYGB into a duodenal switch.  This is a more complex operation, which involves first reconnecting the small gastric pouch from an RYGB back to the old, previously bypassed stomach.  The newly rejoined stomach then is created into a sleeve stomach.  The sleeve stomach is then connected to the end of the small intestine in a duodenal switch configuration.  As evidenced, conversion from an RYGB to a Duodenal switch is a much more complex operation and involves additional surgical connections, which can all increase the risk of the case.  In the majority of cases, our practice prefers a distalization of an RYGB for this reason.

Both a distalization of a RYGB and a conversion of a RYGB to a Duodenal switch offer patients excellent weight loss. Both revisional options can help patients re-achieve the lowest weight that they achieved after their original RYGB, and sometimes even achieve more weight loss than their original RYGB.  As both a distalization and conversion to a duodenal switch are more powerful metabolic surgeries, they require additional vitamin supplementation.  Both surgeries also result in changes in bowel habits, as less fat is absorded after these surgeries. 

There are great options for weight reoccurrence after RYGB.  Talk to your surgeon regarding some of these options!