Secondary surgery after sleeve gastrectomy: Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch

Mar 15, 2015Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery

Second surgery after sleeve gastrectomy: choosing between gastric bypass and duodenal switch

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Abstract

43 patients underwent secondary surgery after laparoscopic sleeve gastrectomy (LSG), with 40% citing inadequate weight loss as the main reason.

Secondary surgery was performed in 25 patients using biliopancreatic diversion with duodenal switch (BPD/DS) and 18 using laparoscopic Roux-en-Y gastric bypass (LRYGB).
The median excess weight loss after 34 months was significantly greater for BPD/DS at 59% compared to LRYGB at 23% (P = .008).
Complaints of dysphagia or gastroesophageal reflux disease resolved after conversion to LRYGB.
BPD/DS was associated with a higher likelihood of short-term complications and vitamin deficiencies compared to LRYGB.

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BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has gained popularity as a stand-alone procedure with good short-term results for weight loss. However, in the long-term, weight regain and other complications are reported. Demand for secondary surgery is rising, partly for these reasons.

OBJECTIVES: To review the indications and effects of secondary surgery, biliopancreatic diversion with duodenal switch (BPD/DS) versus laparoscopic Roux-en-Y gastric bypass (LRYGB), after LSG.

METHODS: Data from all patients who underwent revision of LSG was retrospectively analyzed, concerning data on indications for secondary surgery, weight loss, and complications.

RESULTS: 43 Patients underwent secondary surgery after LSG; 25 BPD/DS and 18 LRYGB, respectively. Main indications for secondary surgery were inadequate weight loss (n = 17 [40%]) and weight regain (n = 8 [19%]). For these indications, the median excess weight loss was greater for BPD/DS (59% [range 15-113]) compared to LRYGB (23% [range -49-84]) (P = .008) after 34 months (range 14-79). In case of dysphagia or gastroesophageal reflux disease the complaints resolved after converting to LRYGB. BPD/DS patients were more likely to develop a short-term complication and vitamin deficiencies compared to LRYGB.

CONCLUSIONS: Secondary surgery of LSG to BPD/DS or LRYGB is feasible with slightly more complications after BPD/DS. Conversion to LRYGB is preferred in cases of dysphagia or gastroesophageal reflux disease. In cases of weight regain or insufficient weight loss after LSG, patients had better weight loss with a BPD/DS; however, this procedure has the risk of complications, such as severe vitamin deficiencies.

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Secondary surgery after sleeve gastrectomy: Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch

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