Long-Term Effectiveness of Laparoscopic Conversion of Sleeve Gastrectomy to a Biliopancreatic Diversion with a Duodenal Switch or a Roux-en-Y Gastric Bypass due to Weight Loss Failure

Jan 29, 2018Obesity surgery

Long-Term Results of Switching Sleeve Gastrectomy to Two Types of Weight-Loss Surgery After Initial Failure

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Abstract

Sixty-six patients underwent conversion from laparoscopic sleeve gastrectomy to alternative bariatric procedures.

21 patients were converted to biliopancreatic diversion with a duodenal switch (DS) and 18 to Roux-en-Y gastric bypass (RYGB).
Before conversion, average weight was 125 kg in the RYGB group and 148 kg in the DS group.
After conversion, the average body mass index (BMI) decreased from 46 to 40.5 in the RYGB group and from 53.7 to 46 in the DS group.
At the last follow-up, RYGB patients experienced a BMI reduction of 8.5-31.9 kg/m and DS patients had a reduction of 12.8-31.9 kg/m.
All comorbidities improved or were in complete remission at the time of follow-up.

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BACKGROUND: Gastroesophageal reflux disease and inadequate weight loss (IWL) are long-term complications of laparoscopic sleeve gastrectomy (LSG) and indications for a laparoscopic conversion to an alternative bariatric procedure. The aim of this study is to report the long-term outcomes of biliopancreatic diversion with a duodenal switch (DS) or a Roux-en-Y gastric bypass (RYGB) as conversion procedures for weight loss failure after LSG.

METHODS: The data of all patients who underwent post-LSG conversion to either a RYGB or a DS at our institution between November 2006 and May 2016 was retrospectively analyzed. Included were all patients with > 1-year follow-up who were operated due to IWL or weight regain. Patients with the indication of reflux were excluded.

RESULTS: Sixty-six patients underwent conversion from LSG to RYGB, DS, or one-anastomosis gastric bypass during the study period. There were 21 revisions to DS and 18 to RYGB that met the inclusion criteria. The respective weight and body mass index (BMI) before and after LSG were 125 and 110 kg and 46 and 40.5 kg/min the RYGB group and 148 and 126 kg and 53.7 and 46 kg/min the DS group. At the last follow-up (> 2 years), 15 RYGB patients had a reduction in BMI of 8.5-31.9 kg/mand 18 DS patients had a reduction in BMI of 12.8-31.9 kg/m. The mean follow-up was 48.5 months (range 24-76). All comorbidities improved or underwent complete remission. 2 2 2 2

CONCLUSION: Conversion from SG to RYGB or DS is an efficient and effective treatment for IWL and improvement of comorbidities. Further studies are warranted to evaluate long-term weight regain.

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Long-Term Effectiveness of Laparoscopic Conversion of Sleeve Gastrectomy to a Biliopancreatic Diversion with a Duodenal Switch or a Roux-en-Y Gastric Bypass due to Weight Loss Failure

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