Genser L, et al. – This work was planned to report the feasibility, safety, and results of laparoscopic reversal of mini–gastric bypass (MGB) to normal anatomy (RMGB) in case of severe and refractory malnutrition syndrome after intensive nutritional support (SRMS). Researchers identified that post–MGB SRMS and its related comorbidities were rare but dreaded conditions. Despite burdened by a significant postoperative morbidity and weight regain, RMGB seemed an effective option to consider, when intensive nutritional support fails.

Methods

• Researchers performed a 10–year retrospective chart review on patients who underwent RMGB (video included) for SRMS following MGB.

Results

• Researchers identified 26 of 2934 patients who underwent a RMGB at a mean delay of 20.9 ± 13.4 months post–MGB.
• Mean body mass index (BMI), excess weight loss (%EWL), and albumin serum level at presentation were 22 ± 4.4 kg/m², 103.6 ± 22.5%, and 25.5 ± 3.6 gr/L, respectively.
• At least one severe malnutrition related complication was encountered in seventeen (63.5%) patients; severe edema in 13 (50%), venous ulcers in 2 (7.7%), infectious complications in 7 (27%), deep venous thrombosis in 5 (19.2%), and motor deficit in 5 (19.2%) patients.
• Surgical exploration showed that 8 of 12 (66.5%) patients had a biliary limb longer than 200 cm and 9 (34.6%) had bile reflux symptoms.
• In the study population, overall morbidity was 30.8% but lower when resecting the entire previous gastrojejunostomy with creation of a new jejunojejunostomy (8.3 vs 50%, p = 0.03).
• After a mean follow–up of 8 ± 9.7 months, a complete clinical and biological regression of the SRMS was observed in all patients after the RMGB despite a mean 13.9 kg weight regain in 16 (61.5%) patients.