Original article
Laparoscopic conversion of sleeve gastrectomy to a biliopancreatic diversion with duodenal switch or a Roux-en-Y gastric bypass due to weight loss failure: our algorithm

https://doi.org/10.1016/j.soard.2014.04.012Get rights and content

Abstract

Background

Failed sleeve gastrectomy (SG), defined by inadequate weight loss or weight regain, can be treated by a laparoscopic conversion to a biliopancreatic diversion with duodenal switch (DS) or a Roux-en-Y gastric bypass (RYGB). We report the outcomes of these procedures after SG failure.

Methods

All patients who underwent DS (n = 9) or RYGB (n = 10) due to inadequate weight loss or weight regain between December 2006 and November 2012 after a failed SG were enrolled.

Results

The mean pre-SG weight and body mass index (BMI) for the DS and RYGB patients were 143±36 kg and 51.5±11 kg/m2 and 120±26 kg and 44.5±5 kg/m2, respectively. The interval between the SG and the conversion to DS and to RYGB was 27±18 months and 36±17 months, respectively. The operation time and hospital stay were 191±64 minutes and 4.3±2.4 days for DS, and 111±37 minutes and 3.1±1.1 days for RYGB. At reoperation, the weight, BMI and percentage of excess weight loss (%EWL) were 113±22 kg, 43±6 kg/m2 and 28±16.5% and 107±27.5 kg, 40±5.7 kg/m2 and 25±12.7% (all P>.05), for the DS and RYGB, respectively. None of the patients were lost to follow-up. The post-DS weight, BMI, and %EWL were 84±19 kg, 30.7±7.4 kg/m2, and 80±40%. The post-RYGB weight, BMI, and %EWL were 81±21 kg, 30.2±4.8 kg/m2, and 65.5±34% (all P> .05).

Conclusion

DS and RYGB are feasible and effective operations after a failed SG. The DS yields a greater weight loss. The mechanism of failure should guide selection of the second procedure.

Section snippets

Patient selection and data sources

This retrospective study examines the data on all patients who underwent the conversion of a failed SG to either a RYGB (10 patients) or a DS (9 patients) at our institution between December 2006 and November 2012. The requirements for conversion were the primary failure of weight loss or the regaining of weight after successful loss (defined as a body mass index [BMI]>35 kg/m2). Only the data on patients with a follow-up of≥6 months and those operated for weight indication were included in the

Results

The data of only 19 patients with at least 6 months of follow-up after the conversion were included in the statistical analysis of the weight loss. Three patients had a former laparoscopic adjustable gastric banding before the SG. Our team performed the SG procedures of 15 of 19 patients and the other 4 were performed in other hospitals.

A total of 19 patients underwent the conversion of a failed SG to either an RYGB (n = 10) or to a DS (n = 9) during the study period. The indications for a

Discussion

SG is currently the most common bariatric procedure in Europe [14]. Its advantages include good and relatively uniform weight loss and the absence of all side effects of bypass procedures, specifically, dumping syndrome, marginal ulcers, and malabsorption. Another advantage is that it can be later converted to a second bariatric procedure in the event of failure to lose an adequate amount of weight. Although technically very simple, a SG can result in various postoperative complications, such

Conclusion

In conclusion, with the continuing rise in the number of SG procedures being performed nowadays, we will soon face a large numbers of patients who will request conversion into a more efficient procedure on a long term. Choosing the best among the currently practiced procedures for a given patient will require solid data, sound clinical judgment, and advanced surgical skills. To date, no prospective trial has been conducted with the aim of determining which conversion bariatric procedure should

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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