DIStal gastriC Bypass OUtcome in Revision SurgEry After Roux-en-y Gastric Bypass (DISCOURSE)
Obesity, Morbid, Weight Gain
About this trial
This is an interventional treatment trial for Obesity, Morbid focused on measuring Obesity, Weight regain, Failed RYGB, Distal gastric bypass
Eligibility Criteria
Inclusion Criteria:
- Age 18-65 years;
- BMI ≥40 kg/m2 or BMI ≥35 kg/m2 with obesity related comorbidity;
- Weight regain or insufficient weight loss (EWL<50% or TWL<20%)15,16 following RYGB;
- Multidisciplinary team screening at one of the bariatric centres;
- Informed consent and willing to enter the follow-up program.
Exclusion Criteria:
- Failed Roux-en-Y gastric bypass due to anatomic, surgical reasons (gastric pouch dilatation >50 mL, gastro-gastric fistula, gastro-jejunostomy);
- Distalisation of RYGB is technical infeasible (judgment by surgeon);
- Inflammatory bowel disease, celiac disease, irritable bowel syndrome and other causes of chronic diarrhea;
- Severe concomitant disease (such as carcinomas and neurodegenerative disorders);
- Pregnant women;
- Noncompliance in follow-up or unwilling to undergo surgery;
- Inability of reading/understanding and filling out questionnaires.
Sites / Locations
- Medisch Centrum LeeuwardenRecruiting
- Rijnstate HospitalRecruiting
- Catharina Ziekenhuis
- Bravis HospitalRecruiting
- Elisabeth-Tweesteden HospitalRecruiting
- OLVGRecruiting
- St. Antonius hospitalRecruiting
- Groene Hart Hospital
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
Distal gastric bypass type I
Distal gastric bypass type II
Laparoscopic distalisation of RYGB type I. The RYGB is modified by dividing the Roux limb (AL) at the jejuno-jejunal anastomosis and re-anastomosed distally to 200 cm from the ileocecal valve using linear staplers, creating a long biliopancreatic limb (BPL). In cases of initial AL lengths shorter than 100 cm, the CC lengths should be adjusted to create a TALL of at least 300 cm.
Laparoscopic distalisation of RYGB type II. The RYGB is modified by dividing the BPL at the jejuno-jejunal anastomosis and re-anastomosed distally to 200 cm from the ileocecal valve using linear staplers, creating a long AL.