To Örebro University

OBJECTIVE: To assess incidence, indications, symptom relief, complications, and weight outcomes following Roux-en-Y gastric bypass (RYGB) reversal. BACKGROUND: RYGB is an effective treatment for obesity but may in rare cases be associated with severe long-term complications requiring RYGB reversal. Evidence on incidence and outcomes is limited.

METHODS: This nationwide, multi-center, retrospective cohort study included all patients undergoing RYGB reversal in Sweden between 2007 and 2023. Data were obtained from the Scandinavian Obesity Surgery Registry (SOReg) and medical records.

RESULTS: During the study period, 199 patients (84% female, mean age 42.5 y) underwent RYGB reversal at 13 centers, corresponding to an incidence of 0.3% of 63,797 RYGB-procedures performed. Patients usually had multiple indications, most often abdominal pain (70%), malnutrition (45%), gastrointestinal symptoms (34%), and postbariatric hypoglycemia (29%). Most procedures (84%) were performed laparoscopically, with a median hospital stay of 4 days. Mean body weight increased from 77 kg at reversal to 89 kg at one year. Overall, 86% of patients reported partial or complete symptom relief, highest rates among those with postbariatric hypoglycemia (94.6%). Early severe complications (Clavien-Dindo grade ≥IIIb) occurred in 24.6% and late severe complications in 21.6%, with seven not surgery-related deaths (3.5%) during follow-up.

CONCLUSIONS: Reversal of RYGB is rare but can be considered in patients with a substantial burden of complications. Although postoperative morbidity was common, most patients achieved symptom relief. Careful patient selection, perioperative optimization, and realistic expectations are essential. Further studies are needed to determine optimal surgical techniques and long-term outcomes.