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Laparoscopic Conversion of Roux-en-Y Gastric Bypass to Sleeve Gastrectomy As First Step of Duodenal Switch: Technique and Preliminary Outcomes

Abstract

Background

Weight loss issues are one of the problems that can affect patients after undergoing bariatric surgery. We report the feasibility, safety and preliminary outcomes of laparoscopic conversion of Roux-en-Y gastric bypass (RYGB) to sleeve gastrectomy (SG), as a first step of duodenal switch (DS), for insufficient weight loss or weight regain.

Patients and Methods

Between August 2007 and November 2009, four patients benefited from laparoscopic conversion for insufficient weight loss or weight regain, mainly due to a new dietary behaviour such as sweet eating. At the time of RYGB, the mean weight and body mass index (BMI) was 118.5 ± 32.8 kg and 43.2 ± 8 kg/m2, respectively. The mean interval time between RYGB and conversion to SG was 36.7 ± 15.6 months. At the time of conversion, the mean weight, BMI, % excess weight loss (%EWL) and % excess BMI loss (%EBMIL) was 101.7 ± 24.7 kg, 37.3 ± 6.6 kg/m2, 27.5 ± 11.8% and 26.5 ± 12%, respectively. The procedure involved the dismantling of both anastomosis, performance of SG before restoration of gastric continuity, and new small bowel anastomosis.

Results

Mean operative time was 233.7 ± 46.4 min. There were no conversions to open surgery and no mortality. One patient developed a gastric fistula. Mean hospital stay was 20.2 ± 17.9 days. After a mean follow-up of 11 ± 12.8 months, the mean weight, BMI, %EWL and %EBMIL was 81 ± 12.1 kg, 30.3 ± 5.1 kg/m2, 59.3 ± 31.5% and 42.3 ± 34.5%, respectively. During follow-up, one patient underwent the second step of DS.

Conclusions

Laparoscopic conversion of RYGB to SG is feasible and safe despite the development of gastric fistula. Weight loss is increased, leaving the patients in better conditions to undergo the second step of DS.

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References

  1. Pories W, Swanson M, MacDonald K. Who would have thought it? An operation to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339–50.

    Article  CAS  PubMed  Google Scholar 

  2. Jones K. Experience with the Roux-en-Y gastric bypass, and commentary on current trends. Obes Surg. 2000;10:183–5.

    Article  PubMed  Google Scholar 

  3. Christou NV, Look D, MacLean LD. Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg. 2006;244:734–40.

    Article  PubMed  Google Scholar 

  4. Deitel M, Crosby RD, Gagner M. The first international consensus summit for sleeve gastrectomy (SG), New York City, October 25–27, 2007. Obes Surg. 2008;18:487–96.

    Article  PubMed  Google Scholar 

  5. Gagner M, Deitel M, Kalberer TL, Erickson AL, Crosby RD. The second international consensus summit for sleeve gastrectomy, March 19–21, 2009. Surg Obes Relat Dis. 2009;5:476–85.

    Article  PubMed  Google Scholar 

  6. Marceau P, Biron S, Hould FS, et al. Duodenal switch: long-term results. Obes Surg. 2007;17:1421–30.

    Article  PubMed  Google Scholar 

  7. Bessler M, Daud A, Digiorgi MF, et al. Adjustable gastric banding as revisional bariatric procedure after failed gastric bypass—intermediate results. Surg Obes Relat Dis. 2010;6:31–5.

    Article  PubMed  Google Scholar 

  8. Gobble RM, Parikh MS, Greives MR, Ren CJ, Fielding GA. Gastric banding as a savage procedure for patients with weight loss failure after Roux-en-Y gastric bypass. Surg Endosc. 2008;22:1019–22.

    Article  PubMed  Google Scholar 

  9. Chin PL, Ali M, Francis K, LePort PC. Adjustable gastric band placed around gastric bypass pouch as revision operation for failed gastric bypass. Surg Obes Relat Dis. 2009;5:38–42.

    Article  PubMed  Google Scholar 

  10. Dapri G, Cadière GB, Himpens J. Laparoscopic placement of non-adjustable silicone ring for weight regain after Roux-en-Y gastric bypass. Obes Surg. 2009;19:650–4.

    Article  PubMed  Google Scholar 

  11. Sugerman HJ, Londrey GL, Kellum JM, et al. Weight loss with vertical banded gastroplasty and Roux-en-Y gastric bypass for morbid obesity with selective versus random assignment. Am J Surg. 1989;157:93–102.

    Article  CAS  PubMed  Google Scholar 

  12. Enjoji M, Nakamuta M. Is the control of dietary cholesterol intake sufficiently effective to ameliorate nonalcoholic fatty liver disease? World J Gastroenterol. 2010;21:800–3.

    Google Scholar 

  13. de Piano A, Tock L, Carnier J, et al. The role of nutritional profile in the orexigenic neuropeptide secretion in nonalcoholic fatty liver disease obese adolescents. Eur J Gastroenterol Hepatol. 2010;22:557-63.

    Google Scholar 

  14. Z’graggen K, Guweidhi A, Steffen R, et al. Severe recurrent hypoglicemia after gastric bypass. Obes Surg. 2008;18:981–8.

    Article  PubMed  Google Scholar 

  15. Fernandez-Esparrach G, Lautz DB, Thompson CC. Peroral endoscopic anastomotic reduction improves intractable dumping syndrome in Roux-en-Y gastric bypass patients. Surg Obes Relat Dis. 2010;6:36–40.

    Article  PubMed  Google Scholar 

  16. Bikman BT, Zheng D, Pories WJ, et al. Mechanism for improved insulin sensitivity after gastric bypass surgery. J Clin Endocrinol Metab. 2008;93:4656–63.

    Article  CAS  PubMed  Google Scholar 

  17. Bantle JP, Ikramuddin S, Kellogg TA, Buchwald H. Hyperinsulinemic hypoglycemia developing late after gastric bypass. Obes Surg. 2007;17:592–4.

    Article  PubMed  Google Scholar 

  18. Patti ME, McMahon G, Mun EC, et al. Severe hypoglycemia post-gastric bypass requiring partial pancreatectomy: evidence for inappropriate insulin secretion and pancreatic islet hyperplasia. Diabetologia 2005;48:2236–40.

    Article  CAS  PubMed  Google Scholar 

  19. Service GJ, Thompson GB, Service FJ, Andrews JC, Collazo-Clavell ML, Lloyd RV. Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery. N Engl J Med. 2005;353:249–54.

    Article  CAS  PubMed  Google Scholar 

  20. Dirksen C, Hansen DL, Madsbad S, et al. Postprandial diabetic glucose tolerance is normalized by gastric bypass feeding as opposed to gastric feeding and is associated with exaggerated GLP-1 secretion: a case report. Diab Care. 2010;33:375–7.

    Article  CAS  Google Scholar 

  21. McLaughlin T, Peck M, Holst J, Deacon C. Reversible hyperinsulinemic hypoglycemia after gastric bypass: a consequence of altered nutrient delivery. J Clin Endocrinol Metab. 2010;95:1851–5.

    Article  CAS  PubMed  Google Scholar 

  22. Dapri G, Cadière GB, Himpens J. Laparoscopic reconversion of Roux-en-Y gastric bypass to original anatomy: technique and preliminary outcomes. Obes Surg 2010. doi:10.1007/s11695-010-0252-6.

  23. Parikh M, Pomp A, Gagner M. Laparoscopic conversion of failed gastric bypass to duodenal switch: technical considerations and preliminary outcomes. Surg Obes Relat Dis. 2007;3:611–8.

    Article  PubMed  Google Scholar 

  24. Thaler K. Treatment of leaks and other bariatric complications with endoluminal stents. J Gastrointest Surg. 2009;13:1567–9.

    Article  CAS  PubMed  Google Scholar 

  25. Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg. 2006;16:1138–44.

    Article  PubMed  Google Scholar 

  26. Iannelli A, Schneck AS, Dahman M, Negri C, Gugenheim J. Two-step laparoscopic duodenal switch for superobesity: a feasibility study. Surg Endosc. 2009;23:2385–9.

    Article  PubMed  Google Scholar 

  27. Scopinaro N, Adami GF, Marinari GM, Traverso E, Papadia F, Camerini G. Biliopancreatic diversion: two decades of experience. In: Deitel M, Cowan GSM, editors. Update: surgery for the morbidly obese patient. Toronto: FD-Communications Inc.; 2000. p. 227–58.

    Google Scholar 

  28. Scopinaro N, Adami GF, Marinari GM, et al. Biliopancreatic diversion. World J Surg. 1998;22:936–46.

    Article  CAS  PubMed  Google Scholar 

  29. Sovik TT, Taha O, Aasheim ET, et al. Randomized clinical trial of laparoscopic gastric bypass versus laparoscopic duodenal switch for superobesity. Br J Surg. 2010;97:160–6.

    Article  CAS  PubMed  Google Scholar 

  30. Prachand VN, Davee RT, Alverdy JC. Duodenal switch provides superior weight loss in the super-obese (BMI > or = 50 kg/m2) compared with gastric bypass. Ann Surg. 2006;244:611–9.

    PubMed  Google Scholar 

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The authors have no commercial associations that might pose a conflict of interest in relation to this article.

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Correspondence to Giovanni Dapri.

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Dapri, G., Cadière, G.B. & Himpens, J. Laparoscopic Conversion of Roux-en-Y Gastric Bypass to Sleeve Gastrectomy As First Step of Duodenal Switch: Technique and Preliminary Outcomes. OBES SURG 21, 517–523 (2011). https://doi.org/10.1007/s11695-010-0249-1

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Keywords

  • Gastric bypass
  • Weight regain
  • Insufficient weight loss
  • Sleeve gastrectomy
  • Duodenal switch
  • Laparoscopy