Laparoscopic Revision of an Enlarged Gastric Outlet After Gastric Bypass

Excess body weight has been shown to have many adverse health effects including, increased
risk of diabetes, hypertension, joint problems and early death. Roux-en-Y gastric bypass has
been shown in the literature to be an effective weight loss surgery in the majority of
patients who are morbidly obese in both short and long term weight loss management. However,
while 80% of patients who undergo gastric bypass lose 67-75% of their excess body weight
within 2 years of surgery, 20% of patients fail to loose or regain a substantial portion of
their excess body weight.1-2 There are several reasons postulated to be the cause in
patients who regain their weight after gastric bypass surgery. These include poor
nutritional choices and eating high caloric carbohydrates in a grazing eating pattern. Also
dilation of the gastric pouch overtime which can decrease the feeling of satiety and allow
for larger meals to be eaten can cause recidivism of obesity. Another problem that can occur
is the enlargement of the gastrojejunostomy anastomosis. Patients who have an opening
larger than 2 cm can have rapid emptying of food into the intestines and decreased satiety
with meals.

Plication is a standard surgical technique of folding or tucking in, which has been used
widely on other parts of the human anatomy. There have been several methods tried in the
past to place plication sutures in the gastrojejunostomy from an endoluminal approach.3-7
These devices have had some success but are not widely used at this time. We aim to
demonstrate that laparoscopic suture plication of the enlarged gastrojejunostomy can provide
a safe and effective minimally invasive method to promote increased weight loss in this
subset of gastric bypass patients who have an enlarged gastric stoma.

Specific Aim 1 To demonstrate that the laparoscopic plication of an enlarged gastric bypass
is a safe surgical option to promote weight loss in the Roux-en-Y gastric bypass patient.

Specific Aim 2 To monitor the effectiveness of long term weight loss after laparoscopic
plication of the gastrojejunostomy in the Roux-en-Y gastric bypass patient

Inclusion Criteria:

1. Adult male or female patients 18 to 65 years old who are able to provide informed
consent for this surgical procedure

2. Patients who have previously had a laparoscopic or open Roux-en-Y gastric bypass
surgery

3. Patients who have regained or failed to lose their excess body weight

Exclusion Criteria:

1. Inability to provide informed consent

2. Patients who have dilated gastric pouch.

3. Patients who have a gastrogastric fistula.

4. Patients who are pregnant or plan to become pregnant during the follow up period.