Factors Determining Conversion from Laparoscopic to Open Roux-en-Y Gastric Bypass

Abstract

Steatohepatitis, diabetes mellitus, adhesions from various causes, previous bile leaks, large waist size, BMI, and weight are predictors for conversion to open surgery.

Laparoscopic vs Open Gastric Bypass in the Management of Morbid Obesity: A 7-year Retrospective Study of 1,364 Patients from a Single Center

“…The conversion rate in this study was 2%. This rate is comparable with the rate of 4.1% in the series by Schwartz et al [22]. The commonest reason for conversion to an open procedure was due to steatohepatitis.…”

Time-course of Changes of Visceral Fat Area, Liver Volume and Liver Fat Area during Intragastric Balloon Therapy in Japanese Super-obese Patients

“…Recently, many bariatric surgeons have tended to prefer sleeve gastrectomy, gastric bypass and gastric banding via laparoscopy rather than the open approach, and the conversion rate from laparoscopic to open bariatric surgery has been an issue under debate. Schwartz et al reported that the most common reasons for conversion in Roux-en-Y gastric bypass is a large liver preventing exposure of the esophagogastric junction (29.3%), and mechanical and technical difficulties such as a thick abdominal wall and large omentum not allowing comfortable manipulation of laparoscopic instruments (24.4%) (10). Meanwhile, previous reports have suggested that preoperative weight reduction with intragastric balloon placement resulted in improvement of the conversion rate from laparoscopic to open surgery, and improvement of the complication rate during laparoscopic gastric band placement.…”

Staged Laparoscopic Roux-en-Y: A Novel Two-Stage Bariatric Operation as an Alternative in the Super-Obese with Massively Enlarged Liver

“…A massively enlarged left lobe of the liver obscures the laparoscopic view of the gastro-esophageal junction and angle of His, making the gastrojejunal anastomosis difficult to construct. Schwartz et al 6 support this concept with their finding that a large liver was the primary reason leading to conversion from laparoscopic to open RYGBP in an analysis of 1,000 patients.…”