Laparoscopic conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: indications and preliminary results

Jul 19, 2016Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery

Reasons for and early results of switching from sleeve gastrectomy to Roux-en-Y gastric bypass using minimally invasive surgery

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Abstract

Forty patients underwent conversion from laparoscopic sleeve gastrectomy to Roux-en-Y gastric bypass, with 72.5% of cases due to weight loss failure.

The mean time from sleeve gastrectomy to conversion was 32.6 months.
Follow-up was conducted for an average of 18.6 months, with a 100% follow-up rate.
Mean total weight loss after conversion was 34.7%, with mean excess weight loss at 64%.
All patients experienced remission of gastroesophageal reflux disease after the procedure.
Postoperative complications occurred in 16.7% of cases, including 5 grade II and 2 grade IIIa complications.
No immediate postoperative mortality was reported.

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BACKGROUND: Laparoscopic sleeve gastrectomy (SG) has gained popularity as a standalone procedure. However, long-term complications are reported, mainly weight loss failure and gastroesophageal reflux disease (GERD). Therefore, demand for revisional surgery is rising.

OBJECTIVES: The aim of this study was to report preliminary results within the 2 main indications for laparoscopic conversion of SG to Roux-en-Y gastric bypass (RYGB).

SETTING: University Hospital, France.

METHODS: Data from all patients who underwent laparoscopic conversion from SG to RYGB were retrospectively analyzed as to indications for revisional surgery, weight loss, and complications.

RESULTS: Forty patients underwent conversion, 29 cases (72.5%) for weight loss failure and 11 cases for refractory GERD (27.5%). The mean interval from SG to RYGB was 32.6 months (range 8-113). Revisional surgery was attempted by laparoscopy in all cases, and conversion to laparotomy was necessary in 3 patients (7.5%). Mean length of follow-up was 18.6 months (range 9-60) after conversion. Follow-up rate was 100%. Mean percent total weight loss and percent excess weight loss were 34.7% and 64%, respectively, when calculated from weight before SG. Remission rate for GERD was 100%. Improvement was observed for all co-morbidities after conversion. There was no immediate postoperative mortality. The postoperative complication rate was 16.7%. According to the Clavien-Dindo classification, there were 5 grade II and 2 grade IIIa complications.

CONCLUSION: Laparoscopic conversion of SG to RYGB is safe and feasible. In the short term, it appears to be effective in treating GERD and inducing significant additional weight loss and improvement of co-morbidities.

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Laparoscopic conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: indications and preliminary results

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