Abstract Introduction Gastric remnant resection during Roux-en-Y gastric bypass (RYGB) is sometimes necessary, particularly in the presence of pre-neoplastic lesions, a family history of gastric cancer, persistent Helicobacter pylori infection or other conditions requiring endoscopic surveillance. Indication may also arise in revisional surgery, namely in cases of bile reflux, refractory marginal ulcer or gastro-gastric fistula. However, it is known to be a surgery associated with increased morbidity. The literature has reported higher rates of fistula formation, haemorrhage, bowel obstruction, ischemia, food intolerance and the higher need for surgical reintervention. Therefore, this study aims to assess the impact of gastric remnant resection on surgical outcomes in a high-volume bariatric surgery center. Methods A retrospective study was conducted including patients who underwent primary or revisional RYGB. Patients were divided into two groups according to whether gastric remnant resection was performed or not. Intraoperative, postoperative complications and weight loss outcomes were analyzed. Reintervention and mortality rates were also assessed. Results A total of 2103 patients were included, of whom 89 (4.2%) underwent gastric remnant resection (Table 1). Overall, the postoperative complication rate was higher in the resection group (14.6% versus 8.9%; P = 0.067), reaching statistical significance in the primary bypass subgroup (16.9% versus 8.7%; P = 0.023). The incidence of anastomotic or staple line leak/fistula was significantly higher in the resection group (2.2% versus 0.2%; P = 0.001), particularly in primary bypass (3.1% versus 0.2%; P 0.001). Food intolerance (2.2% versus 0.3%; P = 0.003) and intra-abdominal collections (2.2% versus 0.2%; P 0.001) were also more frequent in this group. The reintervention rate was higher among patients with resection (7.9% versus 3.1%; P = 0.013). Ninety-day mortality was zero in the resection group, with no significant difference. Despite no clear evidence for improved weight loss with gastric remnant resection, our sample showed a consistent—though not statistically significant—trend favoring resection, particularly in primary RYGB patients (TWL 38.9% versus 36.0%, EWL 99.7% versus 92.0%).These results suggest that, despite being associated with higher surgical morbidity, remnant resection may be linked to enhanced weight loss in select patient populations, particularly after primary procedures. Conclusion Gastric remnant resection during RYGB is associated with a significantly higher incidence of specific complications, including anastomotic fistula, food intolerance, intra-abdominal collections and need for reintervention. Our results suggest a possible relation between remnant resection and better weight loss outcomes. These findings highlight the importance of careful patient selection and individualized surgical decision-making. Despite the increased morbidity, the absence of mortality in this group may reflect the expertise of a high-volume surgical center.
Teixeira et al. (Thu,) studied this question.