Original articleConversion of sleeve gastrectomy to Roux-en-Y gastric bypass: an audit of 34 patients
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.
References (25)
- et al.
Laparoscopic repeat sleeve gastrectomy versus duodenal switch after isolated sleeve gastrectomy for obesity
Surg Obes Relat Dis
(2011) - et al.
Secondary surgery after sleeve gastrectomy: Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch
Surg Obes Relat Dis
(2015) - et al.
Five-year outcomes of gastric bypass for super-super-obesity (BMI>/ = 60 kg/m(2)): a case matched study
Surg Obes Relat Dis
(2015) - et al.
Midterm outcomes of gastric bypass for elderly (aged>/ = 60 yr) patients: a comparative study
Surg Obes Relat Dis
(2015) - et al.
Placement of a laparoscopic adjustable gastric band after failed sleeve gastrectomy
Surg Obes Relat Dis
(2008) - et al.
Laparoscopic magnetic sphincter augmentation vs laparoscopic Nissen fundoplication: a matched-pair analysis of 100 patients
J Am Coll Surg
(2015) - et al.
Gastroesophageal reflux management with the Linx(R) system for gastroesophageal reflux disease following laparoscopic sleeve gastrectomy
J Gastrointest Surg
(2015) - et al.
Laparoscopic sleeve gastrectomy as an initial bariatric operation for high-risk patients: initial results in 10 patients
Obes Surg
(2005) - et al.
Longitudinal gastrectomy as a treatment for the high-risk super-obese patient
Obes Surg
(2004) - et al.
A prospective multicenter study of 163 sleeve gastrectomies: results at 1 and 2 years
Obes Surg
(2008)