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Short or Long Biliopancreatic Limb Bypass as a Secondary Procedure After Failed Laparoscopic Sleeve Gastrectomy

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Abstract

Purpose

Laparoscopic sleeve gastrectomy (SG) may be associated with long-term problems such as insufficient weight loss or weight regain, persistence or relapse of comorbidities, and gastroesophageal reflux disease (GERD). This study analyzes the outcome of patients that underwent conversion of SG to a gastric bypass procedure.

Materials and Methods

All patients that underwent conversion from SG to the following four different gastric bypass procedures were analyzed: short biliopancreatic limb (BPL) bypass types such as proximal Roux-en-Y gastric bypass (PRYGB) or type 2 distal Roux-en-Y gastric bypass (type 2 DRYGB) and long BPL types such as long BPL RYGB or one anastomosis gastric bypass (OAGB).

Results

Between 2012 and 2016, 52 patients received the following revisional procedures after primary SG: proximal RYGB (n = 12, 23.1%), type 2 DRYGB (n = 8, 15.4%), long BPL RYGB (n = 20, 38.5%), and OAGB (n = 12, 23.1%). The long BPL type procedures (long BPL RYGB, OAGB) resulted in a significant long-term additional %EWL (33.8%; 33.2%) at 3 years. In the PRYGB, the effect lasted only for 2 years. In all patients with GERD and dysphagia as the dominant post-SG symptoms, the conversion to a bypass procedure resulted in the complete resolution of these.

Conclusion

In case of weight regain or insufficient weight loss after SG, revisional surgery with a long BPL should be considered. The OAGB provides effective additional weight loss, with low morbidity and malnutrition rates, respectively. Conversion to the malabsorptive long BPL RYGB with a total alimentary limb length below 400 cm should be avoided. Patients that suffer primarily from post-SG GERD or dysphagia should undergo conversion to PRYGB.

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Author notes

  1. Marko Kraljević and Julian Süsstrunk contributed equally to this work.

Authors and Affiliations

  1. Department of Visceral Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases Basel, 4002, Basel, Switzerland

    Marko Kraljević, Ioannis I. Lazaridis & Tarik Delko

  2. Department of General Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland

    Julian Süsstrunk, Thomas Köstler & Urs Zingg

Authors
  1. Marko Kraljević
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  2. Julian Süsstrunk
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  4. Ioannis I. Lazaridis
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Correspondence to Tarik Delko.

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Kraljević, M., Süsstrunk, J., Köstler, T. et al. Short or Long Biliopancreatic Limb Bypass as a Secondary Procedure After Failed Laparoscopic Sleeve Gastrectomy. OBES SURG 31, 170–178 (2021). https://doi.org/10.1007/s11695-020-04868-8

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