Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass to Enhance Weight Loss: Single Enterprise Mid-Term Outcomes and Literature Review

Overview

Journal Bariatr Surg Pract Patient Care

Date 2023 Jan 13

PMID 36636335

Authors

Gabriel Diaz Del Gobbo

Nada Mahmoud

Juan S Barajas-Gamboa

Michael Klingler

Paola Barrios

Carlos Abril

Javed Raza

Ali Aminian

Raul J Rosenthal

Ricard Corcelles

Matthew D Kroh

Affiliations

Soon will be listed here.

Abstract

Background: Suboptimal weight loss (SWL) occurs up to 30% after sleeve gastrectomy (SG). Conversion to Roux-en-Y gastric bypass (cRYGB) has shown heterogeneous results in terms of additional weight loss and resolution of weight-related comorbidities. We aim to evaluate mid-term outcomes of cRYGB specifically for SWL after SG.

Methods: All patients who underwent cRYGB for SWL from April 2010 to June 2019 from prospective registries at three affiliated tertiary care centers were retrospectively reviewed. Patients who underwent revision or conversion for complications were excluded. Mixed-effects and polynomial regression models were used to evaluate weight loss results after conversion.

Results: Thirty-two patients underwent cRYGB from SG. About 68.7% were women with mean age of 46.6 years. Mean body mass index (BMI) before SG was 55.3 kg/m. Before conversion, mean BMI was 44.5 kg/m with 17.3% total weight loss (TWL). All procedures were completed laparoscopically in a median surgical time of 183 min. Three major complications occurred (9.3%), one gastrojejunal (GJ) leak and two reoperations. Four cases (12.5%) of GJ stenosis were diagnosed. No mortality was registered. Mean follow-up time was 24 months and patients had 36 kg/m mean BMI, 17.4% TWL, 27.2% had BMI >35 kg/m.

Conclusions: cRYGB after SG for SWL showed good mid-term results, better than those reported in literature.

Citing Articles

Bariatric Surgical Outcomes in the Elderly: A Comparison Study Between Primary and Revisional Procedures in the United Arab Emirates.

Barajas-Gamboa J, Serra F, Romero-Velez G, Dang J, Diaz Del Gobbo G, Abdallah M Obes Surg. 2024; 34(7):2515-2522.

PMID: 38819724 DOI: 10.1007/s11695-024-07304-3.

References

Clapp B, Wynn M, Martyn C, Foster C, ODell M, Tyroch A . Long term (7 or more years) outcomes of the sleeve gastrectomy: a meta-analysis. Surg Obes Relat Dis. 2018; 14(6):741-747. DOI: 10.1016/j.soard.2018.02.027. View

Gautier T, Sarcher T, Contival N, Le Roux Y, Alves A . Indications and mid-term results of conversion from sleeve gastrectomy to Roux-en-Y gastric bypass. Obes Surg. 2012; 23(2):212-5. DOI: 10.1007/s11695-012-0782-1. View

Sanchez-Pernaute A, Rubio M, Perez N, Marcuello C, Torres A, Perez-Aguirre E . Single-anastomosis duodenoileal bypass as a revisional or second-step operation after sleeve gastrectomy. Surg Obes Relat Dis. 2020; 16(10):1491-1496. DOI: 10.1016/j.soard.2020.05.022. View

De la Cruz M, Busing M, Dukovska R, Torres A, Reiser M . Short- to medium-term results of single-anastomosis duodeno-ileal bypass compared with one-anastomosis gastric bypass for weight recidivism after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2020; 16(8):1060-1066. DOI: 10.1016/j.soard.2020.04.014. View

Aminian A, Zajichek A, Tu C, Wolski K, Brethauer S, Schauer P . How Much Weight Loss is Required for Cardiovascular Benefits? Insights From a Metabolic Surgery Matched-cohort Study. Ann Surg. 2020; 272(4):639-645. DOI: 10.1097/SLA.0000000000004369. View

Ceha C, van Wezenbeek M, Versteegden D, Smulders J, Nienhuijs S . Matched Short-Term Results of SADI Versus GBP After Sleeve Gastrectomy. Obes Surg. 2018; 28(12):3809-3814. DOI: 10.1007/s11695-018-3415-5. View

Aminian A, Vidal J, Salminen P, Still C, Nor Hanipah Z, Sharma G . Late Relapse of Diabetes After Bariatric Surgery: Not Rare, but Not a Failure. Diabetes Care. 2020; 43(3):534-540. DOI: 10.2337/dc19-1057. View

Barajas-Gamboa J, Landreneau J, Abril C, Raza J, Corcelles R, Kroh M . Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass for complications: outcomes from a tertiary referral center in the Middle East. Surg Obes Relat Dis. 2019; 15(10):1690-1695. DOI: 10.1016/j.soard.2019.07.027. View

Stanford F, Alfaris N, Gomez G, Ricks E, Shukla A, Corey K . The utility of weight loss medications after bariatric surgery for weight regain or inadequate weight loss: A multi-center study. Surg Obes Relat Dis. 2016; 13(3):491-500. PMC: 6114136. DOI: 10.1016/j.soard.2016.10.018. View

10.

Iannelli A, Debs T, Martini F, Benichou B, Amor I, Gugenheim J . Laparoscopic conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: indications and preliminary results. Surg Obes Relat Dis. 2016; 12(8):1533-1538. DOI: 10.1016/j.soard.2016.04.008. View

11.

Malinka T, Zerkowski J, Katharina I, Borbely Y, Nett P, Kroll D . Three-Year Outcomes of Revisional Laparoscopic Gastric Bypass after Failed Laparoscopic Sleeve Gastrectomy: a Case-Matched Analysis. Obes Surg. 2017; 27(9):2324-2330. DOI: 10.1007/s11695-017-2631-8. View

12.

Velapati S, Shah M, Kuchkuntla A, Abu-Dayyeh B, Grothe K, Hurt R . Weight Regain After Bariatric Surgery: Prevalence, Etiology, and Treatment. Curr Nutr Rep. 2018; 7(4):329-334. DOI: 10.1007/s13668-018-0243-0. View

13.

Merz A, Blackstone R, Gagner M, Torres A, Himpens J, Higa K . Duodenal switch in revisional bariatric surgery: conclusions from an expert consensus panel. Surg Obes Relat Dis. 2019; 15(6):894-899. DOI: 10.1016/j.soard.2019.03.009. View

14.

AlSabah S, Alsharqawi N, Almulla A, Akrof S, Alenezi K, Buhaimed W . Approach to Poor Weight Loss After Laparoscopic Sleeve Gastrectomy: Re-sleeve Vs. Gastric Bypass. Obes Surg. 2016; 26(10):2302-7. DOI: 10.1007/s11695-016-2119-y. View

15.

Bashah M, Aleter A, Baazaoui J, El-Menyar A, Torres A, Salama A . Single Anastomosis Duodeno-ileostomy (SADI-S) Versus One Anastomosis Gastric Bypass (OAGB-MGB) as Revisional Procedures for Patients with Weight Recidivism After Sleeve Gastrectomy: a Comparative Analysis of Efficacy and Outcomes. Obes Surg. 2020; 30(12):4715-4723. PMC: 7719107. DOI: 10.1007/s11695-020-04933-2. View

16.

Clapp B, Harper B, Dodoo C, Klingsporn W, Barrientes A, Cutshall M . Trends in revisional bariatric surgery using the MBSAQIP database 2015-2017. Surg Obes Relat Dis. 2020; 16(7):908-915. DOI: 10.1016/j.soard.2020.03.002. View

17.

Marti-Fernandez R, Cassinello-Fernandez N, Cuenca-Ramirez M, Lapena-Rodriguez M, Fernandez-Moreno M, Alfonso-Ballester R . Roux-en-Y Gastric Bypass as an Effective Bariatric Revisional Surgery after Restrictive Procedures. Obes Facts. 2020; 13(3):367-374. PMC: 7445544. DOI: 10.1159/000507710. View

18.

Corcelles R, Boules M, Froylich D, Hag A, Daigle C, Aminian A . Total Weight Loss as the Outcome Measure of Choice After Roux-en-Y Gastric Bypass. Obes Surg. 2016; 26(8):1794-8. DOI: 10.1007/s11695-015-2022-y. View

19.

Nergaard B, Leifsson B, Hedenbro J, Gislason H . Gastric bypass with long alimentary limb or long pancreato-biliary limb--long-term results on weight loss, resolution of co-morbidities and metabolic parameters. Obes Surg. 2014; 24(10):1595-602. PMC: 4153949. DOI: 10.1007/s11695-014-1245-7. View

20.

Arman G, Himpens J, Dhaenens J, Ballet T, Vilallonga R, Leman G . Long-term (11+years) outcomes in weight, patient satisfaction, comorbidities, and gastroesophageal reflux treatment after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2016; 12(10):1778-1786. DOI: 10.1016/j.soard.2016.01.013. View