title: Life-threatening side effects of malabsorptive procedures in obese patients necessitating conversion surgery: a review of 17 cases.
abstract: BACKGROUND
  Malabsorptive surgery (MAS) can cause huge weight loss but is also known for its serious side effects. We investigated whether conversion surgery is an effective treatment for MAS-induced complications.
  
  
  METHODS
  We searched our hospital database for patients who underwent conversion surgery after MAS. Any complication was recorded till time of conversion. The conversion techniques and their effect on the course of the patients were analyzed and compared to the situation after MAS.
  
  
  RESULTS
  We identified 17 patients who suffered a wide range of complications after biliopancreatic diversion (BPD) (n = 11), biliopancreatic diversion with duodenal switch (BPD-DS) (n = 4), or distal gastric bypass (D-GBP) (n = 2). After a (mean +/- SD) period of 6.0 +/- 3.6 years the MAS was either converted to a gastric bypass (GBP) in 6 patients or an elongation of the common limb (ECL) in 9 patients. Two conversions were atypical. After a (mean +/- SD) follow-up of 2.4 +/- 2.5 years the majority of blood test results improved. The incidence of most complaints diminished except abdominal discomfort, critical illness polyneuropathy, need for total parenteral nutrition (TPN), wheelchair dependency, and asthenia. One patient died of irreversible liver failure after 3 liver transplantations. Two patients died of cachexia. The preferred conversion technique is still unclear.
  
  
  CONCLUSIONS
  MAS can cause invalidating and life-threatening side effects. If there are signs of incipient deterioration in organ function and/or nutritional status, conversion surgery should not be delayed. Although we have the impression that early conversion causes better outcome, many patients experience lifelong postoperative complications.
authors.affiliation: Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium. wouterwillaert@yahoo.co.uk
authors.forename: W
authors.initials: W
authors.lastname: Willaert
authors.forename: T
authors.initials: T
authors.lastname: Henckens
authors.forename: D
authors.initials: D
authors.lastname: Van De Putte
authors.forename: K
authors.initials: K
authors.lastname: Van Renterghem
authors.forename: W
authors.initials: W
authors.lastname: Ceelen
authors.forename: P
authors.initials: P
authors.lastname: Pattyn
authors.forename: Y
authors.initials: Y
authors.lastname: Van Nieuwenhove
mesh_terms: D000714:Anastomosis, Surgical; D050110:Bariatric Surgery / Q000009:adverse effects*; D015904:Biliopancreatic Diversion; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D008297:Male; D009752:Nutritional Status; D009767:Obesity, Morbid / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D015431:Weight Loss