Abstract Aims The optimal surgical approach for weight regain after Roux-en-Y Gastric Bypass (RYGB) remains controversial. This study presents a personalized surgical method that involves reshaping the gastric pouch, distalization of the biliopancreatic limb (BPL) and proximalization of the alimentary limb (AL). Methods A 39-year-old female patient with a body weight of 177 kg (BMI 66.6 kg/m2) underwent RYGB in 2015. Postoperatively, she achieved a minimum weight of 100 kg but subsequently experienced significant weight regain (%EWL decreasing from 69.6% to 21.7%) reaching a weight of 153 kg (BMI 57.6 kg/m2) over nine years despite comprehensive nutritional, psychological, and pharmacological interventions. Following a multidisciplinary evaluation, revisional bariatric surgery was recommended. Results The surgery was performed laparoscopically. Initial intraoperative measurements were as follows: AL = 160 cm, BPL = 50 cm, and common limb (CL) = 340 cm (total bowel length 550 cm). A slightly dilated gastric pouch was also noted. The patient underwent gastric pouch reshaping, BPL distalization to 200 cm, and AL proximalization to 100 cm, resulting in a common channel of 250 cm. The surgery and postoperative period were uneventful. Two months post-surgery, the patient experienced a weight loss of 15 kg, corresponding to a %EWL of 17.3%. The patient reported no adverse effects and showed satisfactory postoperative recovery, with significant improvements in mobility and overall quality of life. Conclusion This case illustrates an innovative approach involving BPL distalisation at the expense of both the common and alimentary limbs, aligning with a hybrid of types I and IVa according to Hamed et al.’s distalisation terminology. This personalized and aggressive surgical strategy may be effective for superobese patients struggling with weight loss.
Teixeira et al. (Thu,) studied this question.