Outcomes Following Gastric Bypass Reversal for Refractory Complications: A UK Tertiary Centre Retrospective Case Series

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Abstract Background Gastric bypass is an effective and safe metabolic bariatric surgery, yet patients develop refractory long-term complications that exhaust conservative options, prompting consideration of reversal. Outcomes following reversal remain poorly characterised. Methods Performed a retrospective analysis of patients undergoing, or referred after, gastric bypass reversal at a UK tertiary bariatric centre (2019–2026). Eight cases were identified. Data included demographics, pre-reversal complications, nutritional status, operative approach, and post-reversal symptomatic and nutritional outcomes, with follow-up to 24 months. Results The cohort was predominantly female (n=5) with a median age of 41 years (IQR 38–46.5). Index procedures included Roux-en-Y (n=5), one-anastomosis (n=2), and jejunoileal bypass (n=1). Reversals were laparoscopic (n=5) or open (n=2), with one patient referred post-reversal. Median time to reversal was 4.5 years (IQR 2.5–6.5), during which patients underwent a mean of two further interventions. Indications included gastrojejunal stenosis/ulceration, recurrent internal hernias, malabsorption, and dumping syndrome, often with severe weight loss. Median pre-reversal BMI and albumin were 21 kg/m² (IQR 17.3–27) and 30 g/L (IQR 30–39). Post-reversal complications included anastomotic leak, ulcers, and hernia. Symptom resolution was inconsistent; patients reported persistent abdominal pain (6 of 7), reflux (4 of 5), dysphagia (4 of 7), poor intake (3 of 7), and vomiting (3 of 8). Post reversal albumin increased to 38 g/L (IQR 32–41) and BMI to 29 kg/m² (IQR 23.1–33). Conclusion Gastric bypass reversal improved nutritional status but yielded inconsistent symptom relief. Repeated pre-reversal interventions suggest possible delays in definitive decision-making. Prospective multicentre studies are needed to define optimal timing and selection criteria.