Efficacy and safety of revisional treatments for weight regain or insufficient weight loss after Roux‐en‐Y gastric bypass: A systematic review and meta‐analysis

Summary Weight regain or inadequate weight loss following Roux‐en‐Y gastric bypass poses a significant clinical challenge. Our objective was to evaluate various revisional techniques for addressing weight regain and insufficient weight loss after Roux‐en‐Y gastric bypass through a systematic review and meta‐analysis. We performed a literature search (in PubMed and Embase) on revisional interventions in collaboration with a medical information specialist. Measured outcomes included body mass index at intervention, total weight loss during follow‐up, and complications. Random effects models were used to determine pooled effect size and corresponding 95% confidence intervals. Thirty‐nine studies were included: four studies reported on argon plasma coagulation, four studies on transoral outlet reduction, nine studies on transoral outlet reduction + argon plasma coagulation, four studies on pouch/gastrojejunal anastomosis revision, five on laparoscopic gastric banding, two studies on laparoscopic gastric banding + pouch resizing, 10 on distalization‐RYGB, and one on duodenal switch. All techniques resulted in short‐term clinically relevant weight loss. Endoscopic procedures had a short follow‐up and resulted in modest and temporary weight loss. Surgical revision techniques were successful for weight loss in longer term follow‐up, at the expense of high complication rates.