Short or Long Biliopancreatic Limb Bypass as a Secondary Procedure After Failed Laparoscopic Sleeve Gastrectomy

Jul 25, 2020Obesity surgery

Using Short or Long Bypass Surgery After Sleeve Gastrectomy Fails

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Abstract

52 patients underwent conversion from laparoscopic sleeve gastrectomy to various gastric bypass procedures.

Patients who received long biliopancreatic limb (BPL) procedures achieved a significant long-term additional percentage of excess weight loss (%EWL) of 33.8% and 33.2% at 3 years.
The effectiveness of the proximal Roux-en-Y gastric bypass (PRYGB) for weight loss was only sustained for 2 years.
Complete resolution of gastroesophageal reflux disease (GERD) and dysphagia was observed in all patients with these symptoms after conversion to a bypass procedure.
Revisional surgery with a long BPL should be considered for patients experiencing weight regain or insufficient weight loss after sleeve gastrectomy.
The one anastomosis gastric bypass (OAGB) demonstrated effective additional weight loss with low rates of morbidity and malnutrition.

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PURPOSE: Laparoscopic sleeve gastrectomy (SG) may be associated with long-term problems such as insufficient weight loss or weight regain, persistence or relapse of comorbidities, and gastroesophageal reflux disease (GERD). This study analyzes the outcome of patients that underwent conversion of SG to a gastric bypass procedure.

MATERIALS AND METHODS: All patients that underwent conversion from SG to the following four different gastric bypass procedures were analyzed: short biliopancreatic limb (BPL) bypass types such as proximal Roux-en-Y gastric bypass (PRYGB) or type 2 distal Roux-en-Y gastric bypass (type 2 DRYGB) and long BPL types such as long BPL RYGB or one anastomosis gastric bypass (OAGB).

RESULTS: Between 2012 and 2016, 52 patients received the following revisional procedures after primary SG: proximal RYGB (n = 12, 23.1%), type 2 DRYGB (n = 8, 15.4%), long BPL RYGB (n = 20, 38.5%), and OAGB (n = 12, 23.1%). The long BPL type procedures (long BPL RYGB, OAGB) resulted in a significant long-term additional %EWL (33.8%; 33.2%) at 3 years. In the PRYGB, the effect lasted only for 2 years. In all patients with GERD and dysphagia as the dominant post-SG symptoms, the conversion to a bypass procedure resulted in the complete resolution of these.

CONCLUSION: In case of weight regain or insufficient weight loss after SG, revisional surgery with a long BPL should be considered. The OAGB provides effective additional weight loss, with low morbidity and malnutrition rates, respectively. Conversion to the malabsorptive long BPL RYGB with a total alimentary limb length below 400 cm should be avoided. Patients that suffer primarily from post-SG GERD or dysphagia should undergo conversion to PRYGB.

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Short or Long Biliopancreatic Limb Bypass as a Secondary Procedure After Failed Laparoscopic Sleeve Gastrectomy

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