Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass: Is Intrathoracic Migration of the Sleeve of High Incidence?

Jul 8, 2024Obesity surgery

How Often the Stomach Sleeve Moves Upward After Changing Sleeve Gastrectomy to Gastric Bypass Surgery

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Abstract

The average follow-up for 59 patients undergoing conversion from sleeve gastrectomy to Roux-en-Y gastric bypass was 32 months.

In the group operated on for gastroesophageal reflux disease (GERD), 48% had intrathoracic migration of the sleeve, compared to 23% in the weight loss failure group.
Conversion to Roux-en-Y gastric bypass resulted in a 93% improvement in GERD symptoms for patients in that group.
Patients in the weight loss failure group experienced a mean total weight loss percentage of 15.3%, significantly higher than the 4.6% in the GERD group.
The complication rate was 10% within 30 days and 3.4% after 30 days, with no significant differences between the two groups.

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BACKGROUND: Conversion of SG to Roux-en-Y gastric bypass (RYGB) is increasing. Intrathoracic migration of the sleeve (ITM) often seems associated and is increasingly reported.

MATERIAL AND METHODS: Patients who underwent a conversion of SG to RYGB from August 2013 to December 2022 were included. Two groups were compared: patients operated on for weight loss failure (WLF gp) and those operated on for gastroesophageal reflux disease (GERD gp). Demographic data, the incidence of ITM, weight loss outcomes, resolution of symptoms, and morbidity were analyzed.

RESULTS: Fifty-nine patients were included with an average follow-up of 32 months: 46 patients in the GERD gp (78%) were compared to 13 patients (22%) in the WLF gp. Groups were comparable regarding age and gender, but BMI and commodities were significantly higher in the WLF gp. In the GERD gp, on preoperative gastroscopy, 30% had a esophagitis, 48% had an ITM which required a posterior crural closure versus no esophagitis (p=0.02) and 23% of ITM in the WLF gp (p=0.11). Conversion led to 93% of GERD symptom improvement. In the WLF gp, mean TWL% was 15.3%, significantly greater than in the GERD gp (TWL% = 4.6%, p = 0.01). The complication rate was 10% at 30 days and 3.4% after 30 days, not significantly different between groups.

CONCLUSION: The main indication of conversion of SG to RYGB was because of GERD: in these indications, the incidence of ITM was high requiring a surgical treatment with a very good efficacy on symptoms. Weight loss results were disappointing.

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Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass: Is Intrathoracic Migration of the Sleeve of High Incidence?

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