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Laparoscopic Conversion of Gastric Bypass Complication to Sleeve Gastrectomy: Technique and Early Results

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Abstract

Background

Laparoscopic gastric bypass is a commonly performed bariatric surgery for the treatment of morbid obesity. Revision surgery for patients who have gastric bypass complications is a challenge for bariatric surgeon. Our aim is to present the early results of the conversions of gastric bypass complications to sleeve gastrectomies.

Methods

From January 2001 to April 2015, 49 of 2382 gastric bypasses underwent revisional surgery to convert gastric bypasses to sleeve gastrectomies. The demographic data, surgical parameters, and outcomes were studied.

Results

The mean age of the study group was 35.0 years (range 20 to 55), and the average body mass index (BMI) prior to the reoperation was 25.3 kg/m2. Seven patients had previous laparoscopic Roux-en-Y gastric bypasses (LRYGBs), and 42 had laparoscopic single anastomosis (mini-) gastric bypasses (LSAGBs). The main reasons for the revisions were malnutrition (58 %), weight regain (10 %), intolerance (18 %), and others (14 %). The revisional surgeries had longer operative times, greater blood loss, and longer flatus passage times than the primary gastric bypass surgeries. Four patients (8.1 %) developed major complications during revisional surgery, including three (6.1 %) cases of leakage and one (2.0 %) case of internal bleeding. No mortality was noted. After conversion to sleeve gastrectomy, the body weights of the patients remained stable, and all patients improved in terms of malnutrition, including anemia, hypoalbuminemia, and secondary hyperparathyroidism.

Conclusions

Conversion to sleeve gastrectomy is an effective and safe option for patients with gastric bypass complications. The conversions to sleeve gastrectomy resulted in significant improvements in malnutrition and maintained weight loss at the early follow-ups.

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References

  1. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.

    Article  CAS  PubMed  Google Scholar 

  2. Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.

    Article  PubMed  Google Scholar 

  3. Langer FB, Bohdjalian A, Shakeri-Leidenmühler S. Conversion from sleeve gastrectomy to Roux-en-Y gastric bypass—indications and outcome. Obes Surg. 2010;20:835–40.

    Article  PubMed  Google Scholar 

  4. Truss TL. National trends in utilization and outcomes in bariatric surgery. Surg Endosc. 2005;19:616–20.

    Article  Google Scholar 

  5. Irani K, Youn H, Ren-Fielding C, et al. Midterm results for gastric banding as salvage procedure for patients with weight loss failure after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2011;7:219–24.

    Article  PubMed  Google Scholar 

  6. Sugerman HJ, Kellum JM, DeMaria EJ. Conversion of proximal to distal gastric bypass for failed gastric bypass for superobesity. J Gastrointest Surg. 1997;1:517–24.

    Article  CAS  PubMed  Google Scholar 

  7. Rawlins ML, Teel D, Hedgeorth K, et al. Revision of Roux-en-Y gastric bypass to distal bypass for failed weight loss. Surg Obes Relat Dis. 2011;7:45–9.

    Article  PubMed  Google Scholar 

  8. Lee WJ, Lee YC, Ser KH, et al. Revisional surgery for laparoscopic minigastric bypass. Surg Obes Relat Dis. 2011;7:486–92.

    Article  PubMed  Google Scholar 

  9. Al-Bader I, Khoursheed M, Sharaf K, et al. Revisional laparoscopic gastric pouch resizing for inadequate weight loss after Roux-en-Y gastric bypass. Obes Surg. 2015;25:1103–8.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Goyal V, Holover S, Garber S. Gastric pouch reduction using StomaphyX in post Roux-en-Y gastric bypass patients does not result in sustained weight loss: a retrospective analysis. Surg Endosc. 2013;27(9):3417–20.

    Article  PubMed  Google Scholar 

  11. Eid GM, McCloskey CA, Eagleton JK, et al. StomaphyX vs. a sham procedure for revisional surgery to reduce regained weight in Roux-en-Y gastric bypass patients: a randomized clinical trial. JAMA Surg. 2014;149:372–9.

    Article  PubMed  Google Scholar 

  12. Gitelis M, Ujiki M, Farwell L, et al. Six month outcomes in patients experiencing weight gain after gastric bypass who underwent gastrojejunal revision using an endoluminal suturing device. Surg Endosc. 2015;29:2133–40.

    Article  CAS  PubMed  Google Scholar 

  13. Parikh M, Pomp A, Gagner A. 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 

  14. Dapri G, Cadière GB, Himpens J. Laparoscopic reconversion of Roux-en-Y gastric bypass to original anatomy: technique and preliminary outcomes. Obes Surg. 2011;21:1289–95.

    Article  PubMed  Google Scholar 

  15. Deitel M, Gagner M, Erickson AL, et al. Third international summit: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2011;7(6):749–59.

    Article  PubMed  Google Scholar 

  16. Rosenthal RJ, Diaz AA, Arvidsson D, et al. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8:8–19.

    Article  PubMed  Google Scholar 

  17. Peterli R, Borbely Y, Ker B, et al. Early results of the Swiss multicentre bypass or sleeve study (SM-BOSS): a prospective randomized trial comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Ann Surg. 2013;258:690–5.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Vix M, Liu KH, Diana M, et al. Impact of Roux-en-Y gastric bypass versus sleeve gastrectomy on vitamin D metabolism: short-term results from a prospective randomized clinical trial. Surg Endosc. 2014;28:821–6.

    Article  PubMed  Google Scholar 

  19. Lee WJ, Pok EH, Almulaifi A, et al. Medium-term results of laparoscopic sleeve gastrectomy: a matched comparison with gastric bypass. Obes Surg. 2015;25:1431–8.

    Article  PubMed  Google Scholar 

  20. Vilallonga R, van de Vrande S, Himpens J. Laparoscopic reversal of Roux-en-Y gastric bypass into normal anatomy with or without sleeve gastrectomy. Surg Endosc. 2013;27:4640–8.

    Article  PubMed  Google Scholar 

  21. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lee W, Yu P, Wang W, et al. Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a prospective randomized controlled trial. Ann Surg. 2005;242:20–8.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lee WJ, Ser KH, Lee YC, et al. Laparoscopic Roux-en-Y vs. mini-gastric bypass for the treatment of morbid obesity: a 10-year experience. Obes Surg. 2012;22:1827–34.

    Article  PubMed  Google Scholar 

  24. Bruzzi M, Rau C, Voron T, et al. Single anastomosis or mini-gastric bypass: long-term results and quality of life after a 5-year follow-up. Surg Obes Relat Dis. 2015;11:321–7.

    Article  PubMed  Google Scholar 

  25. Karefylakis C, Naslund I, Edholm D, et al. Prevalence of anemia and related deficiencies 10 years after gastric bypass—a retrospective study. Obes Surg. 2015;25:1019–23.

    Article  PubMed  Google Scholar 

  26. von Drygalski A, Andris DA. Anemia after bariatric surgery: more than just iron deficiency. Nutr Clin Pract. 2009;24:217–26.

    Article  Google Scholar 

  27. Kwon Y, Kim HJ, Lo ME. Anemia, iron and vitamin B12 deficiencies after sleeve gastrectomy compared to Roux-en-Y gastric bypass: a meta-analysis. Surg Obes Relat Dis. 2014;10:589–97.

    Article  PubMed  Google Scholar 

  28. Trastulli S, Desiderio J, Guarino S, et al. Laparoscopic sleeve gastrectomy compared with other bariatric surgical procedures: a systematic review of randomized trials. Surg Obes Relat Dis. 2013;9:816–29.

    Article  PubMed  Google Scholar 

  29. Himpens J, Coromina L, Verbrugghe A, et al. Outcomes of revisional procedures for insufficient weight loss or weight regain after Roux-en-Y gastric bypass. Obes Surg. 2012;22:1746–54.

    Article  PubMed  Google Scholar 

  30. Schimizu H, Annaberdyev S, Motmarry I, et al. Revisional bariatric surgery for unsuccessful weight loss and complications. Obes Surg. 2013;23:1766–73.

    Article  Google Scholar 

  31. Carter CO, Fernandez AZ, McNatt SS, et al. Conversion from gastric bypass to sleeve gastrectomy for complications of gastric bypass. Surg Obes Relat Dis. 2015. doi:10.1016/j.soard.2015.07.001.

    Google Scholar 

  32. Brolin RE, Cody RP. Impact of technological advances on complications of revisional bariatric operations. J Am Coll Surg. 2008;206:1137–44.

    Article  PubMed  Google Scholar 

  33. Yazbek T, Safa T, Denis R, et al. Laparoscopic sleeve gastrectomy (LSG)—A good bariatric option for failed laparoscopic adjustable gastric banding (LAGB): a review of 90 patients. Obes Surg. 2013;23:300–5.

    Article  PubMed  Google Scholar 

  34. Alqahtanig AR, Elahmedi M, Alamri H, et al. Laparoscopic removal of poor outcome gastric banding with concomitant sleeve gastrectomy. Obes Surg. 2013;23:782–7.

    Article  Google Scholar 

  35. Noel A, Schneck AS, Nedelcu M, et al. Laparoscopic sleeve gastrectomy as a revisional procedure for failed gastric banding: lessons from 300 consecutive cases. Surg Obes Relat Dis. 2014;10:1116–22.

    Article  PubMed  Google Scholar 

  36. Iannelli A, Schneck AS, Ragot E, et al. Laparoscopic sleeve gastrectomy as revisional procedure for failed gastric banding and vertical banded gastroplasty. Obes Surg. 2009;19:1216–20.

    Article  PubMed  Google Scholar 

  37. Brolin RE, Lin JM. Treatment of gastric leaks after Roux-en-Y gastric bypass: a paradigm shift. Surg Obes Relat Dis. 2013;9(2):229–33.

    Article  PubMed  Google Scholar 

  38. Fernandez Jr AZ, DeMaria EJ, Tichansky DS, et al. Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc. 2004;18(2):193–7.

    Article  PubMed  Google Scholar 

  39. Hallowell PT, Stellato TA, Yao DA, et al. Should bariatric revisional surgery be avoided secondary to increased morbidity and mortality? Am J Surg. 2009;197(3):391–6.

    Article  PubMed  Google Scholar 

  40. Simper SC, Erzinger JM, McKinlay RD, et al. Laparoscopic reversal of gastric bypass with sleeve gastrectomy for treatment of recurrent retrograde intussusception and Roux stasis syndrome. Surg Obes Relat Dis. 2010;6(6):684–8.

    Article  PubMed  Google Scholar 

  41. Moon RC, Ashley F, Teixeira AF, et al. Indications and outcomes of reversal of Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2015;11(4):821–6.

    Article  PubMed  Google Scholar 

  42. Zachariah PJ, Lee W-J, Ser K-H, et al. Laparo-endoscopic gastrostomy (LEG) decompression: a novel one-time method of management of gastric leaks following sleeve gastrectomy. Obes Surg. 2015;25(11):2213–8.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Min-Sheng General Hospital, Tauoyan, Taiwan

    Chung-Yen Chen, Wei-Jei Lee, Hui-Ming Lee, Jung-Chien Chen, Kong-Han Ser & Shu-Chun Chen

  2. Department of surgery, E-DA Hospital, Kaohsiung, Taiwan

    Chung-Yen Chen & Hui-Ming Lee

  3. Department of International Business, Chien Hsin University of Science and Technology, Tauoyan, Taiwan

    Yi-Chih Lee

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  1. Chung-Yen Chen
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Correspondence to Wei-Jei Lee.

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Informed consent was obtained from all individual participants included in the study.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Chen, CY., Lee, WJ., Lee, HM. et al. Laparoscopic Conversion of Gastric Bypass Complication to Sleeve Gastrectomy: Technique and Early Results. OBES SURG 26, 2014–2021 (2016). https://doi.org/10.1007/s11695-016-2066-7

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