Roux-en-Y Gastric Bypass Distalization for Insufficient Weight Loss or Weight Regain: a Systematic Review and Meta-Analysis

Abstract

Background: Weight Regain or Insufficient Weight Loss after primary Roux-en-Y Gastric Bypass (RYGB) poses a significant challenge for bariatric surgeons. Distalization of RYGB serves as a revisional malabsorptive procedure, potentially offering a solution, albeit with associated complications. This review and meta-analysis aim to enhance the evidence base concerning the safety and efficacy of several Distalization variants. Methods: Following PRISMA recommendations, we conducted a systematic review and meta-analysis across three databases (PubMed, Scopus, and Web of Science). Primary outcomes included short-term (1 year), mid-term (2-3 years), and long-term (5 years) weight loss progress. Secondary outcomes encompassed early postoperative complications, comorbidity resolution, hypoalbuminemia, Protein Energy Malnutrition (PEM), and the need for surgical revision. Subgroup analyses categorized patients based on Total Alimentary Limb Length (TALL) and Common Limb (CL) lengths, as well as by the type of Distalization performed. Results: Our analysis comprised 18 studies. Across all studies, %Excess Weight Loss (%EWL) was 59.4% (short-term), 58.6% (mid-term), and 67.5% (long-term). Subgroup analysis revealed that TALL < 325cm correlated with improved weight loss but increased PEM risk compared to TALL ≥ 325cm. Similarly, CL < 125cm was associated with higher complication rates than CL ≥ 125cm. Type I surgery yielded superior weight loss compared to Type III at short and mid-term. High heterogeneity was noted among results. Conclusions: A TALL above 325-350 cm and a CL above 125-150 cm seem to offer a potentially safer approach, while maintaining favorable weight loss outcomes. Type I Distalization demonstrated the most promising weight loss pattern. Enhanced standardization in surgical practice and terminology is imperative for comprehensive evaluation of Distalization outcomes.