RNY GASTRIC BYPASS TO RNY REVISION

Service Description

A Roux-en-Y Gastric Bypass to Roux-en-Y revision is a complex, highly specialized revisional bariatric surgery, typically performed when a primary RYGB (often done laparoscopically) has failed due to complications or inadequate outcomes. This type of revision is sometimes referred to as RYGB-to-RYGB revision, revisional Roux-en-Y, or redo RYGB. 🔁 RNY Gastric Bypass to RNY Revision Correcting or optimizing a previously performed Roux-en-Y Gastric Bypass Why Would a Patient Need a RYGB Revision? - Weight regain: Due to pouch or stoma dilation, poor restriction, or behavioral adaptation - Gastric pouch/stoma failure: Enlarged pouch or gastrojejunostomy - Refractory dumping syndrome: Excessive glucose dumping due to rapid gastric emptying - Marginal ulcer: At the gastrojejunal anastomosis, often chronic or recurrent - Nutritional deficiencies: In cases of severe malabsorption or bypass length issues - Persistent or recurrent GERD: If the anatomy is no longer protective - Technical complications: Hernias, strictures, adhesions, or ulceration What Does the Revision Involve? The revision is tailored to the underlying issue and may include: - Enlarged pouch: Pouch resizing or complete pouch recreation - Dilated gastrojejunostomy: Redo of the anastomosis or addition of a restrictive band - Weight regain: Limb lengthening (alimentary or biliopancreatic) to increase malabsorption - Ulceration: Revision of the anastomosis, vagotomy in some cases - Dumping syndrome: Pouch resizing and adjustment of anastomosis to slow gastric emptying - Internal hernias: Hernia repair and mesenteric defect closure How Is It Different from the First RYGB? - Scar tissue and adhesions are more extensive - The procedure requires meticulous dissection of prior anatomy - Stapling or suturing near previous anastomoses increases risk of leak - May require intraoperative endoscopy to evaluate anatomy ⚠️ Challenges and Risks - Anatomical complexity: Prior scarring and altered landmarks - Leak risk: Higher than in primary bypass procedures - Longer operative time: Often 2–4 hours, depending on case - Nutritional risks: Especially if malabsorption is increased - Healing complications: Reoperation risk may reach 10–15% in complex cases 🧠 Summary A RYGB-to-RYGB revision is a powerful but challenging operation reserved for patients who fail to respond or develop complications after their initial gastric bypass.