Original article
Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: an audit of 34 patients

https://doi.org/10.1016/j.soard.2016.02.039Get rights and content

Abstract

Background

Weight loss failure and proton pomp inhibitor (PPI)-resistant gastroesophageal reflux diseases (GERD) after sleeve gastrectomy (SG) are frequently encountered.

Objectives

The aim of this study was to evaluate the efficacy and risks of SG conversion to Roux-en-Y gastric bypass (RYGB) in the case of weight loss failure or severe GERD.

Setting

University hospitals.

Methods

Between March 2007 and December 2014, 34 patients with history of SG underwent RYGP. A retrospective analysis of a prospectively collected database was undertaken.

Results

Among 34 patients, 31 underwent revisional surgery for weight loss failure and 3 for PPI-resistant GERD. Six patients in the weight loss failure group had symptomatic GERD that was effectively treated with PPIs. The average body mass index (BMI) was 53±11 kg/m2 before SG. A laparoscopic approach was performed in 94% of patients. There was no postoperative mortality. Major adverse events (<90 days) occurred in 4 patients (11.7%). The mean length of stay was 6.7±2.8 days. At the time of revisional surgery, the mean BMI, percentage excess weight loss, and percentage weight loss were 44.7±9.8 kg/m2, 33.6±27.1%, and 16±9.7%, respectively, compared with 40.9±8.5 kg/m2, 63.1±36.2%, and 23.8±14% at 3 years. The GERD was resolved in all patients, allowing the cessation of PPI medication.

Conclusion

Laparoscopic conversion of SG to RYGB is feasible and it allows improvement in secondary weight loss and GERD, but at the cost of high morbidity.

Section snippets

Patients

All patients undergoing bariatric surgery since January 2004 in 2 referral obesity and metabolic surgery centers were prospectively included in an electronic database. A retrospective review of the prospective database of all consecutive patients with a history of SG converted to RYGB for failure in terms of weight loss or regain and GERD resistant to PPI medication was undertaken. All patients followed the guidelines for bariatric surgery according to the French High Authority of Health (Haute

Morbidity

The Clavien–Dindo classification was used to grade postoperative complications [16].

Weight

Baseline weight (kg) and BMI (kg/m2) were defined as weight and BMI before any bariatric surgery. Maximal %EWL was defined as the sum of %EWL after SG and RYGB. Maximal percentage of weight loss (%WL) was defined as the sum of %WL after SG and RYGB.

Co-morbidities

Resolution of GERD was defined as clinical absence of GERD and definitive cessation of PPI medication. Improvements in diabetes, hypertension, and OSAS were defined

Patients and procedure characteristics

Of 622 patients who underwent SG between March 2007 and December 2014, 34 (5.4%) underwent secondary conversion to RYGB. The indications for surgery were weight loss failure (n = 31) and GERD resistant to PPI medication (n = 3). There were 26 females (76.5%). The baseline characteristics are shown in Table 1. Besides 3 patients with GERD resistant to PPI, 6 others had GERD that was effectively treated by PPI (40 mg/d). Two patients with resistant GERD were under the limit of BMI 35 at the time

Discussion

The number of SGs performed is constantly growing. Like all bariatric procedures, SG can present long-term failures (up to 20%) [6] in terms of insufficient weight loss or progressive weight regain and functional complications such as severe refractory GERD or dysphagia due to mediogastric stenosis.

Weight regain after SG can be conditioned by modifications in eating behavior due to lack of nutritional or dietary follow-up, which may be responsible for an increase in long-term oral food volume

Conclusion

Our results suggest that conversion of SG to RYGB seems feasible and achieves satisfactory weight loss and successful treatment of GERD, but at the cost of high morbidity.

Conflict of Interest

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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