Outcomes of laparoscopic revisional conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: Diff erent strategies for obese and non-obese Asian patients

Jul 17, 2022Asian journal of surgery

Results of minimally invasive surgery changing sleeve stomach surgery to gastric bypass in obese and non-obese Asian patients using different approaches

AI simplified

GLP-1 Therapies on OpenScience ↗PubMed ↗DOI ↗

Abstract

Fifty-five patients underwent revisional laparoscopic Roux-en-Y gastric bypass after sleeve gastrectomy for intractable gastroesophageal reflux disease.

Mean age of the patients was 42.5 years, with a mean body mass index before sleeve gastrectomy of 34.6 kg/m².
The average time from sleeve gastrectomy to revision surgery was 51.2 months.
After one year, all patients reported improved gastroesophageal reflux disease symptoms, but only 60% were able to discontinue proton pump inhibitor therapy.
Obese patients who received long biliopancreatic limb Roux-en-Y gastric bypass experienced a significantly higher percentage of total weight loss compared to non-obese patients (9.1% vs. -3.1%).
There were no significant differences in baseline characteristics between obese and non-obese groups prior to revision surgery, except for higher mean body mass index, blood pressure, and triglycerides in the obese group.

AI simplified

BACKGROUND: Sleeve gastrectomy (SG) is the most performed bariatric procedure now. Some patients would necessitate a revision to Roux-en-Y gastric bypass (RYGB) as a salvage procedure for intractable gastroesophageal reflux disease (GERD). However, outcome of the revision in Asians with co-existed obesity and those non-obese is not clear.

METHODS: We retrospectively reviewed the data of patients who underwent revisional laparoscopic RYGB after SG between 2007 and 2019 for intractable GERD with data of one year follow-up. Pre-operative clinical data, perioperative outcomes, GERD symptoms, weight loss and medication details were analyzed. Patients were classified into those with body mass index (BMI) ≥ 25 and < 25 kg/m. 2

RESULTS: Fifty-five patients (44 women, 11 men; mean age 42.5 years) were included. Mean interval from the initial SG to revision surgery was 51.2 months (range, 5-132). Mean body mass index before SG was 34.6 kg/m, whereas that before revision surgery was 27.6 kg/m. All the patients required continue proton pump inhibitor (PPI) to control the GERD symptoms before surgery. Among them, 36 (65.4%) patients in the obese group received long BP limb (>100 cm) RYGB for associated obesity but the common channel was assured to ≥ 400 cm or 70% of small bowel length, the other 19 (34.6%) patients in the non-obese group received standard BP limb (<100 cm) RYGB. There was no difference in basic characters between the two groups before revision surgery except a higher mean BMI (30.0 vs. 22.2 kg/m, p < 0.001), blood pressure and triglyceride in obese group. One year after revision surgery, all the patients had improved GERD symptoms but only 33 (60%) can completely wave PPI, without difference between the 2 groups. Obese group with a long BP limb RYGB had a significant higher % total weight loss (TWL) than non-obese group (%TWL 9.1% vs. -3.1%, p = 0.005). 2 2 2

CONCLUSION: Laparoscopic revision to RYGB is a safe and effective treatment for patients with intractable GERD after SG but some patients may still have residual GERD symptoms. Using a modified RYGB technique in revision surgery may help in weight reduction for obese Asian patients.

Full Text

Full text is available at the source.

View full text (XML) ↗View full text ↗

Outcomes of laparoscopic revisional conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: Diff erent strategies for obese and non-obese Asian patients

Abstract

Full Text

You found one interesting study. We’ll send the next 7.

what lands in your inbox each week:

Recent issues from the glp-1 therapies brief

Abstract

Full Text

Related papers

You found one interesting study. We’ll send the next 7.

what lands in your inbox each week:

Recent issues from the glp-1 therapies brief