Proximal Jejuno-Ileal Bypass as Revision of Roux-en-Y Gastric Bypass

• Published in: Obesity surgery Vol. 34; no. 8; pp. 2880 - 2887
• Main Authors: Vélez Londoño, José Pablo, Salazar Solarte, Aura María, Toro Arana, Diego Fernando, Guerrero Forero, Sara, Ortiz Restrepo, Andrés Felipe, Abreu Lomba, Alin, Rivera Martínez, Wilfredo Antonio
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-08-2024; Springer Nature B.V
• Subjects: Adult; Aged; Female; Gastric Bypass; Gastrointestinal surgery; Humans; Jejunoileal Bypass - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Obesity; Obesity, Morbid - surgery; Original Contributions; Reoperation - statistics & numerical data; Surgery; Treatment Outcome; Weight control; Weight Loss; Proximal jejuno-ileal bypass surgery; Obesity; Metabolic surgery; Roux-en-Y gastric bypass
• DOI: 10.1007/s11695-024-07322-1
• EISSN: 1708-0428
• ISSN: 0960-8923; 1708-0428

Introduction
Bariatric surgery is established as a possibility for the treatment of obesity, allowing weight reduction and remission of obesity comorbidities. Reported suboptimal clinical response rates are as high as 30–60% (insufficient weight loss or gain, defined as BMI greater than 35 kg/m
2
or excess weight loss less than 50%). Proximal jejuno-ileal bypass (PJIBP) is a promising option when re-intervention is required.
Objectives
To describe the standardization of a proprietary technique of modified PJIBP as a management procedure in patients with post-gastric bypass recurrent weight gain or insufficient post-intervention weight loss.
Methods
This study evaluated a case series of 10 Latin American patients requiring post-bariatric re-intervention, between February 2018 and 2023, in a single-metabolic surgery center in Cali-Colombia.
Results
Median age was 45 years (26–70 RIC), 60% female, and 40% male. Mean BMI at conversion was 36.7 kg/m
2
(6.4 SD). Median follow-up was 22 months (RIC 16–30). Mean percentage of excess weight lost was 78% (22.4 SD). One hundred percent achieved glycemia control, only one patient persisted with dyslipidemia, and no patient presented hypoalbuminemia. At the end of follow-up, 100% received vitamin supplementation.
Conclusion
PJIBP could be an effective procedure, associated with positive results in relation to weight loss and resolution of obesity comorbidities. Deficiencies of fat-soluble vitamins and protein malnutrition represent the main concern in the long term, so multidisciplinary management and continuous follow-up are required.
Graphical Abstract