Watson MD, et al. – Authors planned this work to assess the effect of previous non–bariatric foregut surgery on subsequent Roux–en–Y gastric bypass (RYGB). Although increased technical difficulty and increase perioperative morbidity were encountered, patients undergoing RYGB with previous non–bariatric foregut surgery had long–term symptom resolution and robust weight loss. This indicates that in the right hands, RYGB after non–bariatric foregut surgery could be performed safely and effectively.

Methods

• Authors performed a retrospective review of 2089 patients undergoing RYGB between January 1985 and June 2015 to identify all patients with previous non-bariatric foregut surgery.
• Retrospective chart review was performed to collect perioperative and postoperative data.

Results

• Researchers identified 11 patients with prior non-bariatric foregut surgery who underwent RYGB with median time between operations of 95.6 months.
• Of note, previous Nissen fundoplication was observed in 7/11 (63.6%).
• They observed conversion to open operation in 3/7 (42.9%) with previous Nissen compared to 1/4 (25%) in those without previous Nissen.
• In this study, the average length of stay (LOS) was 3.9 ± 0.9 days, significantly longer than their institutional average for RYGB of 3.2 ± 3.2 days (p = 0.02).
• Findings revealed mean percentage of excess body mass index loss (%EBMIL) of 64.7 ± 23.5 at 4-year median follow-up, which was comparable to their institution’s previously reported data.
• It was realized that no mortalities were attributed to RYGB and the overall complication rate was 18.2%, compared to their institutional complication rate for RYGB of 8.5% (p = 0.253).