Short-term outcomes of sleeve gastrectomy conversion to R-Y gastric bypass: multi-center retrospective study

Apr 21, 2018Langenbeck's archives of surgery

Short-term results of changing sleeve gastrectomy to gastric bypass surgery: a multi-center retrospective study

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Abstract

In a study of 30 patients converted from laparoscopic sleeve gastrectomy to laparoscopic R-Y gastric bypass, 83% experienced resolution of severe gastro-esophageal reflux disease.

Conversion to R-Y gastric bypass was performed for insufficient weight loss, weight regain, or severe gastro-esophageal reflux disease.
Surgical complications occurred in 10% of patients during the conversion procedure.
Mean body mass index at the time of conversion was 36 kg/m².
Post-conversion mean body mass index decreased to 30.8 kg/m², 28 kg/m², and 28 kg/m² after 6, 12, and 24 months, respectively.
Overall, 96% of patients reported satisfaction with the procedure after a mean follow-up of 24 months.

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INTRODUCTION: The outcomes of failed laparoscopic sleeve gastrectomies (LSG) converted to laparoscopic standard R-Y gastric bypass (LRYGB) in case of insufficient weight loss (IWL), weight regain (WR), and/or severe gastro-esophageal reflux disease (GERD) are scanty.

PURPOSE: To evaluate incidence, indications, and short-term outcomes of LSG conversion to LRYGB in three bariatric centers.

METHODS: Patients operated between January 2012 and December 2016 by primary LSG, with mean follow-up of 24 months and converted to LRYGB for IWL, WR, and/or GERD, were retrospectively analyzed for demographics, operative details, perioperative complications, comorbidities evolution, and further WL.

RESULTS: Thirty patients (2.76%, 7 M/23 F, mean age 41 ± 10.1 years, initial mean BMI 46.9 ± 6.3 kg/m) were successfully converted after a mean period of 33 ± 27.8 months for severe GERD (15 patients, 50%), GERD and IWL/WR (3 patients, 10%), and IWL/WR (12 patients, 40%). Surgical complications occurred in three patients (10%). Mean BMI at revision time was 36 ± 9 kg/m, and 30.8 ± 5.2, 28 ± 4.9, and 28 ± 4.3 kg/mafter 6, 12, and 24 months, respectively. Resolution of GERD was achieved in 83% of cases. Overall, postoperative satisfaction was reported by 96% of the cases, after mean follow-up of 24 ± 8.9 months. 2 2 2

CONCLUSIONS: In high-volume centers, where strict criteria for patients' selection for LSG are applied, the expected incidence of reoperations for "non-responder" (IWL/WR) or de novo or persistent severe GERD non-responder to medical treatment is low (< 3%). Conversion of "non-responder" LSG to LRYGB is effective for further WL and GERD remission at short term (2 years follow-up); however, a high postoperative complication rate was observed. Long-term multidisciplinary follow-up is mandatory to confirm data on WL durability and comorbidity control.

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Short-term outcomes of sleeve gastrectomy conversion to R-Y gastric bypass: multi-center retrospective study

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