Approach to Poor Weight Loss After Laparoscopic Sleeve Gastrectomy: Re-sleeve Vs. Gastric Bypass

Mar 16, 2016Obesity surgery

Comparing Re-sleeve and Gastric Bypass for Poor Weight Loss After Sleeve Gastrectomy

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Abstract

A mean excessive weight loss percentage of 61.3% was observed after converting laparoscopic sleeve gastrectomy to laparoscopic Roux-en-Y gastric bypass over one year.

Conversion from laparoscopic sleeve gastrectomy to laparoscopic Roux-en-Y gastric bypass was performed in 12 patients due to inadequate weight loss.
A separate group of 24 patients underwent conversion to laparoscopic re-sleeve gastrectomy for similar reasons.
Prior to conversion, the average body mass index was 52 for the Roux-en-Y group and 50 for the re-sleeve group.
The excessive weight loss percentage after the initial sleeve gastrectomy was 37.9% for the Roux-en-Y group and 43% for the re-sleeve group.
No complications were recorded during the conversion procedures.
Comparison of excessive weight loss percentages between the two conversion methods showed no significant difference.

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BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is increasing worldwide; however, long-term follow-up results included insufficient weight loss and weight regain. This study aims at assessing the outcomes of converting LSG to laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic re-sleeve gastrectomy (LRSG).

METHODS: A total of 1300 patients underwent LSG from 2009 to 2012, of which 12 patients underwent LRYGB and 24 patients underwent LRSG in Al-Amiri Hospital alone. Data included length of stay, percentage excessive weight loss (EWL%), and body mass index (BMI).

RESULTS: Twenty-four patients underwent conversion from LSG to LRSG, and 12 patients underwent conversion from LSG to LRYGB due to insufficient weight loss and weight regain. Eighty-five percent were females. The mean weight and BMI prior to LSG for the LRYGB and LRSG patients were 136.5 kg and 52, and 134 kg and 50, respectively. The EWL% after the initial LSG was 37.9 and 43 %, for LRYGB and LRSG, respectively. There were no complications recorded. Results of conversion of LSG to LRYGB involved a mean EWL% 61.3 % after 1 year (p value 0.009). Results of LRSG involved a mean EWL% of 57 % over interval of 1 year (p value 0.05). Comparison of the EWL% of LRYGB and LRSG for failed primary LSG was not significant (p value 0.097).

CONCLUSION: Following our algorithm, revising an LSG with an LRSG or LRYGB for poor weight loss is feasible with good outcomes. Larger and longer follow-up studies are needed to verify our results.

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Approach to Poor Weight Loss After Laparoscopic Sleeve Gastrectomy: Re-sleeve Vs. Gastric Bypass

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