Revision of primary sleeve gastrectomy to Roux-en-Y gastric bypass: indications and outcomes from a high-volume center

Casillas, Robert A.; Um, Scott; Getty, Jorge L. Zelada; Sachs, Samantha; Kim, Benjamin B.

doi:10.1016/j.soard.2016.09.038

Cited by 93 publications

(41 citation statements)

References 25 publications

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“…Sheppard et al[42] found similar results. On the contrary, other authors reported high rates of failure of PPI therapy, suggesting revisional surgery in patients with refractory GERD after LSG[57,58]. …”

Section: Treatment Options Of Gerd In Patients After Lsg: the Presentmentioning

confidence: 99%

Gastroesophageal reflux disease and morbid obesity: To sleeve or not to sleeve?

Rebecchi

Allaix

Patti

et al. 2017

WJG

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Laparoscopic sleeve gastrectomy (LSG) has reached wide popularity during the last 15 years, due to the limited morbidity and mortality rates, and the very good weight loss results and effects on comorbid conditions. However, there are concerns regarding the effects of LSG on gastroesophageal reflux disease (GERD). The interpretation of the current evidence is challenged by the fact that the LSG technique is not standardized, and most studies investigate the presence of GERD by assessing symptoms and the use of acid reducing medications only. A few studies objectively investigated gastroesophageal function and the reflux profile by esophageal manometry and 24-h pH monitoring, reporting postoperative normalization of esophageal acid exposure in up to 85% of patients with preoperative GERD, and occurrence of de novo GERD in about 5% of cases. There is increasing evidence showing the key role of the surgical technique on the incidence of postoperative GERD. Main technical issues are a relative narrowing of the mid portion of the gastric sleeve, a redundant upper part of the sleeve (both depending on the angle under which the sleeve is stapled), and the presence of a hiatal hernia. Concomitant hiatal hernia repair is recommended. To date, either medical therapy with proton pump inhibitors or conversion of LSG to laparoscopic Roux-en-Y gastric bypass are the available options for the management of GERD after LSG. Recently, new minimally invasive approaches have been proposed in patients with GERD and hypotensive LES: the LINX® Reflux Management System procedure and the Stretta® procedure. Large studies are needed to assess the safety and long-term efficacy of these new approaches. In conclusion, the recent publication of pH monitoring data and the new insights in the association between sleeve morphology and GERD control have led to a wider acceptance of LSG as bariatric procedure also in obese patients with GERD, as recently stated in the 5th International Consensus Conference on sleeve gastrectomy.

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Section: Treatment Options Of Gerd In Patients After Lsg: the Presentmentioning

confidence: 99%

Gastroesophageal reflux disease and morbid obesity: To sleeve or not to sleeve?

Rebecchi

Allaix

Patti

et al. 2017

WJG

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“…Reflux has been shown as the most common indication for reoperation after SG, and it is often associated with hiatal hernia [18]. A previous study from a high-volume bariatric center reported 1.2% conversions from SG to RYGB, and 62.5% were due to postoperative GERD with or without insufficient weight loss [18]. During the followup, we performed 13 (3.2%) reoperations after SG due to difficult postoperative reflux, with 76.9% total recovery from any reflux-related symptoms.…”

Section: Discussionmentioning

confidence: 99%

Is preoperative gastroscopy necessary before sleeve gastrectomy and Roux-en-Y gastric bypass?

Saarinen

Kettunen

Pietiläinen

et al. 2018

Surgery for Obesity and Related Diseases

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“…Revisional bariatric surgery has shown variable outcomes with weight loss when compared to the primary procedure. Indeed, in some observational studies, it has yielded lower total weight loss, with inferior durability [24][25][26] . However, the same assumptions of inferiority should not be made for the effect of revisional surgery on diabetes.…”

Section: Revisional Surgerymentioning

confidence: 99%