Argon Plasma Coagulation of Gastrojejunal Anastomosis for Weight Regain After Gastric Bypass

Background The failure of approximately 20 % of obese patients who undergo Roux-en-Y gastric bypass (RYGB) to maintain weight loss over the following 18–24 months is related to the surgical procedure, to the patient, or both. Although the underlying mechanisms are uncertain, one factor that has been...

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Bibliographic Details
Published in:Obesity surgery 2015, Vol.25 (1), p.72-79
Main Authors: Baretta, Giorgio A. P., Alhinho, Helga C. A. W., Matias, Jorge Eduardo F., Marchesini, João Batista, de Lima, João Henrique F., Empinotti, Celso, Campos, Josemberg M.
Format: Article
Language:English
Subjects:
Adult
Anastomosis, Roux-en-Y - adverse effects
Anastomosis, Roux-en-Y - methods
Argon Plasma Coagulation - adverse effects
Argon Plasma Coagulation - methods
Body Mass Index
Dilatation, Pathologic - surgery
Endoscopy - methods
Female
Gastric Bypass - adverse effects
Gastric Bypass - methods
Gastrointestinal surgery
Humans
Jejunum - surgery
Male
Medical procedures
Medicine
Medicine & Public Health
Middle Aged
Obesity
Obesity, Morbid - surgery
Original Contributions
Reoperation - methods
Surgery
Treatment Failure
Treatment Outcome
Weight
Weight Gain
Young Adult
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Summary:Background The failure of approximately 20 % of obese patients who undergo Roux-en-Y gastric bypass (RYGB) to maintain weight loss over the following 18–24 months is related to the surgical procedure, to the patient, or both. Although the underlying mechanisms are uncertain, one factor that has been postulated is the dilation of the gastrojejunal anastomosis. The objective was to evaluate the safety and efficacy of the serial use of argon plasma coagulation (APC) in reducing the diameter of the dilated gastrojejunal anastomosis and post-RYGB weight regain. Methods We carried out a prospective, nonrandomized study of 30 patients, with no control or sham group, monitoring RYGB weight regain associated with dilation of the gastrojejunal anastomosis over a postoperative period of 18 months. Each patient underwent three sessions of APC in the anastomosis separated by 8 weeks, with a final endoscopic examination 8 weeks after the last session. Results There was a loss of 15.48 kg (range = 8.0–16.0 kg) of the 19.6 kg (range = 7.0–39.0 kg) of regained weight after RYGB and a reduction of 66.89 % in the final anastomotic diameter, with statistically significant reductions between each APC session. Previous body mass index significantly decreased up to the final examination, and the final weight was close to but not at the same level as the nadir. Conclusions Our study indicates that the use of APC to treat weight regain after RYGB is a safe and effective procedure and promotes a reduction in gastrojejunal anastomosis, final weight, and BMI, with a low rate of complications.
ISSN:0960-8923
1708-0428
DOI:10.1007/s11695-014-1363-2