title: 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.
  
  
  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/m(2), 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/m(2), 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/m(2), 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.
authors.affiliation: Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, 322, Rue Haute, 1000, Brussels, Belgium. giovanni@dapri.net
authors.forename: Giovanni
authors.initials: G
authors.lastname: Dapri
authors.forename: Guy Bernard
authors.initials: GB
authors.lastname: Cadière
authors.forename: Jacques
authors.initials: J
authors.lastname: Himpens
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D017211:Treatment Failure; D016896:Treatment Outcome; D015430:Weight Gain; D015431:Weight Loss