Indications and Mid-Term Results of Conversion from Sleeve Gastrectomy to Roux-en-Y Gastric Bypass

Abstract

Sleeve gastrectomy (SG) is currently considered as a primary bariatric surgery. This is because of its relative simplicity and satisfactory results. As observed with other bariatric procedures, surgeons are confronted with insufficient weight loss or weight regain, insufficient resolution of metabolic disorders, and intractable severe reflux. A retrospective analysis of conversion from SG to Roux-en-Y gastric bypass (RYGBP) was performed to assess weight loss, diabetes resolution, and relief of reflux symptoms. The mean interval between the two procedures was almost 24 months. Eighteen patients underwent conversion from SG to RYGBP for insufficient weight loss (n = 9), severe reflux (n = 6), and persistence of type 2 diabetes mellitus (T2DM) (n = 3). The median follow-up was 15.5 months. Weight loss was significantly improved with a mean percentage of excess of body mass index loss at 64.6 % after conversion versus 47.1 % before conversion. All reflux symptoms were immediately relieved without any medication at the end of the follow-up. The three patients who had an operation for persistence of T2DM are now free of medication. Only one postoperative complication was observed as a small bowel injury, which was treated surgically. Conversion from SG to RYGBP is safe. Severe reflux is definitely treated and is an incontestable indication with this procedure. Additionally, weight loss and diabetes are clinically improved. Our results appear to be similar to those with a primary RYGBP.

Impact of sustained weight loss achieved through gastric gastric sleeve surgery with circulating level of obestatin hormone in Iraqi obese subjects

“…The present study showed a significant decline in body mass index, waist circumference, and fat percent among patients undergone gastric sleeve surgery with a significant differences between patient and controls which is agreed by Gautier T et al (13)indicated that weight loss was significantly improved after bariatric surgery (mean loss percentage of excess of body weight, 64.6 % versus 47.1 %) and all reflux symptoms are eliminated without any medication at the end of the follow-up. Several studies have demonstrated that the amelioration of metabolic dysfunction is attributable not only to weight loss and caloric restriction, but also to endocrine changes resulting from surgical manipulation of the gut.…”

Three-Year Outcomes of Revisional Laparoscopic Gastric Bypass after Failed Laparoscopic Sleeve Gastrectomy: a Case-Matched Analysis

“…Langer et al reported the conversion of 8 patients from LSG to LRYGB with a mean weight reduction of 15.2 ± 8.0 kg at a mean follow-up duration of 33 months [22]. Gautier et al reported on 18 patients who were converted to RYGB for different indications and illustrated effective weight loss results [23]. In summary, only a few studies documented outcome data for more than 2 years.…”

Gastroesophageal Reflux Disease and Sleeve Gastrectomy

“…The Roux-en-Y loop avoids biliary reflux and exerts a downward pulling effect that retains the gastric pouch into the abdomen. For these reasons, when doing a conversion from LSG into RYGB [42], the pouch must be resized and any persistent gastric fundus has to be resected [43]. The hiatus should be carefully inspected for the presence of hiatal hernia as we found that in the long term the latter may be responsible for the migration of the gastric pouch into the thorax, although this condition may cause dysphagia which requires surgical treatment [44].…”