Original articleLaparoscopic 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
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.
References (23)
- et al.
Systematic review of sleeve gastrectomy as staging and primary bariatric procedure
Surg Obes Relat Dis
(2009) - et al.
Laparoscopic repeat sleeve gastrectomy versus duodenal switch after isolated sleeve gastrectomy for obesity
Surg Obes Relat Dis
(2011) - et al.
Gastrocolic fistula after re-sleeve gastrectomy: outcomes after esophageal stent implantation
Surg Obes Relat Dis
(2010) - et al.
Laparoscopic sleeve gastrectomy followed by duodenal switch in selected patients versus single-stage duodenal switch for super obesity: case-control study
Surg Obes Relat Dis
(2013) - et al.
Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient
Obes Surg
(2003) - et al.
Staged laparoscopic sleeve gastrectomy followed by Roux-en-Y gastric bypass for morbidly obese patients: a risk reduction strategy
Obes Surg
(2008) - et al.
Short- and mid-term outcomes of sleeve gastrectomy for morbid obesity: the experience of the Spanish National Registry
Obes Surg
(2009) - et al.
Gastric leak after laparoscopic sleeve gastrectomy for obesity
Obes Surg
(2009) - et al.
Reinforcing the staple line during laparoscopic sleeve gastrectomy: prospective randomized clinical study comparing three different techniques
Obes Surg
(2010) - et al.
Laparoscopic seromyotomy for long stenosis after sleeve gastrectomy with or without duodenal switch
Obes Surg
(2009)