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Short-term outcomes of sleeve gastrectomy conversion to R-Y gastric bypass: multi-center retrospective study

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Abstract

Introduction

The outcomes of failed laparoscopic sleeve gastrectomies (LSG) converted to laparoscopic standard R-Y gastric bypass (LRYGB) in case of insufficient weight loss (IWL), weight regain (WR), and/or severe gastro-esophageal reflux disease (GERD) are scanty.

Purpose

To evaluate incidence, indications, and short-term outcomes of LSG conversion to LRYGB in three bariatric centers.

Methods

Patients operated between January 2012 and December 2016 by primary LSG, with mean follow-up of 24 months and converted to LRYGB for IWL, WR, and/or GERD, were retrospectively analyzed for demographics, operative details, perioperative complications, comorbidities evolution, and further WL.

Results

Thirty patients (2.76%, 7 M/23 F, mean age 41 ± 10.1 years, initial mean BMI 46.9 ± 6.3 kg/m2) were successfully converted after a mean period of 33 ± 27.8 months for severe GERD (15 patients, 50%), GERD and IWL/WR (3 patients, 10%), and IWL/WR (12 patients, 40%). Surgical complications occurred in three patients (10%). Mean BMI at revision time was 36 ± 9 kg/m2, and 30.8 ± 5.2, 28 ± 4.9, and 28 ± 4.3 kg/m2 after 6, 12, and 24 months, respectively. Resolution of GERD was achieved in 83% of cases. Overall, postoperative satisfaction was reported by 96% of the cases, after mean follow-up of 24 ± 8.9 months.

Conclusions

In high-volume centers, where strict criteria for patients’ selection for LSG are applied, the expected incidence of reoperations for “non-responder” (IWL/WR) or de novo or persistent severe GERD non-responder to medical treatment is low (< 3%). Conversion of “non-responder” LSG to LRYGB is effective for further WL and GERD remission at short term (2 years follow-up); however, a high postoperative complication rate was observed. Long-term multidisciplinary follow-up is mandatory to confirm data on WL durability and comorbidity control.

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Authors and Affiliations

  1. Department of Medico-Surgical Sciences and Biotechnologies, Division General Surgery and Bariatric Center of Excellence-IFSO, “Sapienza” University of Rome, ICOT Hospital, Via F. Faggiana, 1668, Latina, Italy

    Cristian Eugeniu Boru & Gianfranco Silecchia

  2. Department of General Surgery, Andosilla Hospital, ASL VT, Civita Castellana, Italy

    Francesco Greco

  3. Department of Endocrine and Metabolic Surgery, “A. Gemelli” Foundation, Catholic University, Rome, Italy

    Piero Giustacchini & Marco Raffaelli

Authors
  1. Cristian Eugeniu Boru
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  2. Francesco Greco
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  3. Piero Giustacchini
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  4. Marco Raffaelli
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  5. Gianfranco Silecchia
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Contributions

Dr. Cristian Boru and Prof. Gianfranco Silecchia participated in the study conception and design; Dr. Cristian Boru, Dr. Piero Giustacchini, and Dr. Francesco Greco participated in the acquisition of data; Dr. Cristian Boru participated in the analysis and interpretation of data; Dr. Cristian Boru participated in the drafting of the manuscript; Prof. Gianfranco Silecchia participated in the critical revision of the manuscript.

Corresponding author

Correspondence to Cristian Eugeniu Boru.

Ethics declarations

Ethical approval

No ethical approval was required for this study. Permission was granted by the Institutional Review Board for this retrospective study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent was not required. Informed consent was obtained from all individual participants included in the study. This article does not contain any studies with animals performed by any of the authors.

Conflict of interest

The authors declare that they have no conflict of interest.

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Boru, C.E., Greco, F., Giustacchini, P. et al. Short-term outcomes of sleeve gastrectomy conversion to R-Y gastric bypass: multi-center retrospective study. Langenbecks Arch Surg 403, 473–479 (2018). https://doi.org/10.1007/s00423-018-1675-0

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  • DOI: https://doi.org/10.1007/s00423-018-1675-0

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