Revisions/Conversions from Roux-en-Y Gastric Bypass due to Weight Recurrence

Roux-en-Y gastric bypass (RYGB) stands as the current surgical standard of care for sustained weight loss in patients with obesity. Long-term studies have shown that up to half of the patients who underwent RYGB eventually experienced weight recurrence (WR) after 10–15 years of surgery. Nevertheless, multiple therapeutic options for the management of WR after primary RYGB are available such as behavioral modifications, medications, endoscopic interventions, and surgical revisions/conversions. Surgical options include laparoscopic pouch resizing and/or revision of the gastrojejunal anastomosis, adjustable/non-adjustable gastric banding, distalizing RYGB, and conversion to biliopancreatic diversion with duodenal-switch or single-anastomosis duodeno-ileal bypass with sleeve. While considering the optimal option for this patient population, different factors should be considered such as long-term weight-loss outcomes, technical difficulties, and complication rates. A multidisciplinary, individualized approach remains essential to optimize long-term results.