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Sleeve Gastrectomy Failure—Revision to Laparoscopic One-Anastomosis Gastric Bypass or Roux-n-Y Gastric Bypass: a Multicenter Study

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Abstract

Introduction

Laparoscopic sleeve gastrectomy (LSG) is the most popular bariatric procedure performed worldwide. However, many patients undergo secondary surgery due to either weight-related and complication-related reasons or both. Conversional options vary with one-anastomosis gastric bypass (OAGB) and Roux-n-Y gastric bypass (RYGB) being the most common. The aim of the study was to assess the safety and efficacy of converting failed LSG to either OAGB or RYGB, and compare weight-related results and post-conversion complications.

Methods

Retrospective review of hospital records of patients who underwent conversion from LSG to either RYGB or OAGB due to insufficient weight loss or weight regain in 7 bariatric centers between 2013 and 2019. Data retrieved included demographics, anthropometrics, comorbidities, indication for conversion, conversion type, complications, and weight loss.

Results

During the study period, 396 patients were included in the study. Eighty-four (21%) patients were lost to follow-up. RYGB and OAGB were performed in 119 and 144 patients, respectively. Mean age and body mass index (BMI) at revision were 44.2 years (range 19–72) and 40.6 ± 5.9 kg/m2 (range 35–71), respectively. Of these, 191 (73%) were female. Percent total body weight loss (%TWL) was 16% ± 1% for the RYGB group vs. 23% ± 12% for the OAGB group (p = 0.0007) at a median follow-up of 29 months (range 7–78 months) following conversion. Gastroesophageal reflux disease (GERD) was significantly higher 1 year following conversion to OAGB vs. RYGB occurring in 25 (17.4%) and 9 (7.6%) patients, respectively (p = 0.018).

Conclusions

Conversion of LSG to OAGB, compared to RYGB, results in increased weight loss but a higher rate of GERD and potential nutritional deficiencies.

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Abbreviations

BPD/DS:

biliopancreatic diversion ± duodenal switch

GERD:

gastroesophageal reflux disease

IDA:

iron deficiency anemia

IWL:

inadequate weight loss

LSG:

laparoscopic sleeve gastrectomy

OAGB:

one-anastomosis gastric bypass

RYGB:

Roux-en-Y gastric bypass

SADI:

single anastomosis duodenal-ileal bypass

TWL:

total weight loss

WR:

weight regain

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Author information

Authors and Affiliations

  1. Department of Surgery C, Chaim Sheba Medical Center, 2 Sheba Rd., 52610, Ramat Gan, Israel

    Shlomi Rayman, Dan Assaf & David Goitein

  2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Shlomi Rayman & David Goitein

  3. Bariatric Center, Herzliya Medical Center, 7 Ramat Yam St, 4685107, Herzliya, Israel

    Carmil Azran

  4. Department of General Surgery, Bnai-Zion Medical Center, Haifa, Israel

    Gideon Sroka

  5. Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel

    Gideon Sroka

  6. Department of General Surgery, Rambam Health Care Campus and the Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel

    Ahmad Assalia

  7. Department of Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus, 91240, Jerusalem, Israel

    Nahum Beglaibter

  8. Department of Surgery, Hadassah-Hebrew University Medical Center, Ein-Kerem Campus, Jerusalem, Israel

    Ram Elazary

  9. Department of General Surgery, The Tel-Aviv Sourasky Medical Center of Medicine, Tel Aviv University, Tel-Aviv-Yafo, Israel

    Shai Meron Eldar

  10. Israel Center for Disease Control, Ministry of Health, Tel Hashomer Campus, 56261, Ramat Gan, Israel

    Orly Romano-Zelekha

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  1. Shlomi Rayman
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Correspondence to Shlomi Rayman.

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Rayman, S., Assaf, D., Azran, C. et al. Sleeve Gastrectomy Failure—Revision to Laparoscopic One-Anastomosis Gastric Bypass or Roux-n-Y Gastric Bypass: a Multicenter Study. OBES SURG 31, 2927–2934 (2021). https://doi.org/10.1007/s11695-021-05334-9

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