IBC Oxford University Poster Abstract 27 - Is distalization a good option for insufficient weight loss or weight regain after Roux-en-Y gastric bypass? The initial experience of a differentiated center

Abstract Introduction Bariatric surgery is recognized as the most effective long-term treatment for clinically severe obesity, leading to sustained weight loss. Among the common bariatric procedures, the laparoscopic Roux-en-Y gastric bypass (RYGB) is frequently performed and is known for its significant weight loss results and its ability to reduce obesity-related comorbidities in many patients. However, 10% to 40% of patients may experience insufficient weight loss (IWL) or weight regain (WR), along with the persistence or recurrence of comorbidities after 5 to 7 years, presenting a major challenge for bariatric surgeons. The distalisation of RYGB, a revisional malabsorptive procedure, can potentially address these issues but comes with its own complications. Methods We reviewed all distalisations of RYGB performed at our hospital between 2019 and 2023. During this period, a total of 2117 RYGB surgeries were performed. The primary outcomes assessed were weight loss progress and changes in comorbidities. Secondary outcomes included early postoperative complications and the need for surgical revisions. Results A total of 13 distalisations of RYGB type I (BPL distalisation) were performed, all on female patients with a median age of 49 years. The median BMI was 50.7 kg/m2 at the initial bypass and 41.2 kg/m2 before the distalisation. The median interval between the two surgeries were 103 months. In all the cases, the common limb length was more than 2.5 m and there was a median length of 2.32 m of the biliopancreatic limb. Total weight loss was 27.7% at 6 months, 30% at 1 year (n = 9), 25.2% at 1.5 years (n = 7), and 24.1% at 2 years (n = 6). Among the four patients with hypertension before the revisional surgery, there was one patient with remission at 6 months post-surgery, while the others continued to have hypertension. There were no cases of diabetes mellitus, dyslipidaemia, or sleep apnoea syndrome prior to the surgery. However, one patient developed diabetes mellitus 6 months post-surgery. The average surgery duration was 107 minutes, and patients were discharged after 2 days. There were no complications, and no surgical revisions were required. The median follow-up time was 23 months. Discussion Our hospital’s experience with distalisation procedures demonstrates that this surgery is both safe and effective, leading to significant BMI reduction without malnutrition. Furthermore, the initial surgery was highly effective in reducing comorbidities, as most patients had remission of these conditions following gastric bypass. Conclusions The limited number of cases hinders our ability to draw definitive conclusions. Increasing the number of cases will be crucial for obtaining more reliable results.