Revision of Primary Sleeve Gastrectomy to Roux-en-Y Gastric Bypass: Indications and Outcomes from a High-volume Center

Background: Laparoscopic sleeve gastrectomy (SG) has become an accepted primary bariatric operation. Like other bariatric operations, inadequate weight loss and complications have been reported.

Objectives: The aim of this study was to assess the indications and outcomes of revision of SG to laparoscopic Roux-en-Y gastric bypass (RYGB) at a single community hospital.

Setting: Community hospital, United States.

Methods: Retrospective review of a prospectively collected database identifying SG operations done from February 2009 to June 2014. All patients who underwent revision from SG to RYGB were studied.

Results: Forty-eight patients underwent revision of SG to RYGB. Mean time to revision was 26 months (range, 2-60 mo) and mean follow up after RYGB was 20 months (range, 4-48 mo). Indications for revision were reflux (n = 14), inadequate weight loss (n = 11), reflux and inadequate weight loss (n = 16), stricture (n = 4), chronic leak (n = 1), and recurrent diabetes and reflux (n = 2). Reflux symptoms resolved in 96% of patients after revision, and hiatal hernias were repaired in 50% of patients. Percentage total weight loss at 3, 6, 12, 24, and 36 months was 9.0%, 12.9%, 15.7%, 13.3%, and 6.5%, respectively. The overall rate of complication was 31%. There were no mortalities.

Conclusions: Revision of SG to RYGB is a potentially effective means of treating SG complications, particularly reflux. Reflux was the most common indication for revision and was often associated with a hiatal hernia. Further studies will be necessary to evaluate the long-term maintenance of additional weight loss after revision of SG to RYGB.