Laparoscopic reversal of bariatric bypass: indications persist, risk depends on hypoalbuminaemia, not surgical approach.

Background: In the last quarter of the twentieth century, over 100 000 jejuno-ileal bypasses (JIBP) were performed since the first description by Kermen in 1954. In the mean time, the long-term metabolic risks of this procedure is well known. Although there are more optimistic reports concerning the bilio-pancreatic bypass (BPBP, Scopinaro), our own experience is otherwise. We continue to see patients with both types of bypass requiring reversal for the same indications. Could these patients be offered the advantages of laparoscopic reversal? Methods: In the period between April 1996 and April 2001, all 17 patients presenting for reversal were considered for laparoscopy. The technique is presented elsewhere. Results: There were five planned open reversals, four conversions from laparoscopy to open and eight complete laparoscopic reversals. Of 17 reversals, 12 were for JIBP and 5 for BPBP. In the open group, there were two fatalities and two patients with complicated course. One patient in the laparoscopic group had an anastomotic leak requiring reoperation. All the patients who died or suffered complication had a preoperative plasma albumin below 30 g L-1 (median: 21 g L-1 ), whereas all the uncomplicated patients had values greater than 30 g L-1 (median: 40 g L-1 ). Conclusion: These data show that laparoscopic reversal is usually technically feasible. Since most patients require a secondary bariatric procedure, the low potential for adhesions is of value. Furthermore, many patients continue to have an abnormal body image. The statistically significant difference in albumin levels, not the surgical approach, appears to dictate the outcome. [ABSTRACT FROM AUTHOR]