title: Laparoscopic omega-loop gastric bypass for the conversion of failed sleeve gastrectomy: early experience.
abstract: OBJECTIVE
  Despite the initial effectiveness of sleeve gastrectomy (SG), some patients who undergo this purely restrictive technique have inadequate weight loss or renewed weight gain and persistent obesity-related co-morbidities with their potentially lethal complications. In such patients, the conversion of SG by the addition of a malabsorptive technique may then be necessary.
  
  
  METHODS
  Conversion of SG to a mini gastric bypass (MGBP) was evaluated for failure of weight loss. An ante-colic end-to-side stapled gastro-jejunal anastomosis was performed laparoscopically, connecting the long narrow gastric tube to the jejunum at a point 200cm downstream from the ligament of Treitz.
  
  
  RESULTS
  Between October 2006 and February 2012, 651 laparoscopic MGBP were performed for morbid obesity. Twenty-three of these patients (3.5%) had previously undergone SG. The conversion from SG to MGPB was performed laparoscopically in 19 of the 23 patients (81%) at a mean interval of 26.3months (8.2-63.7). The 30-day postoperative mortality rate was zero and the morbidity rate was 9.5%. The mean BMI before MGBP was 44±7.7kg (35.8-55.4). Conversion of SG to MGBP resulted in additional weight loss, achieving a mean BMI of 39.9 with a 26.8% loss of excess BMI (EBL) at 3months, mean BMI of 36.5 with 37.2% EBL at 12months, mean BMI of 36.2 with 48.6% EBL at 18months, and mean BMI of 35.7 with EBL of 51.6% at 24months. The overall mean EBL was 57.3±19.5% (range: 25-82%) at 42.3months (range 16.7-60.8months).
  
  
  CONCLUSIONS
  Conversion of SG to MGBP is feasible, safe and effective, and results in significant additional weight loss. Definitive results at 2 and 5years are awaited for the long-term procedure validation.
authors.affiliation: Université Paris-5, Assistance Publique-Hôpitaux de Paris, Paris, France; Service de chirurgie digestive, Hôpital Européen Georges-Pompidou, Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Moszkowicz
authors.forename: C
authors.initials: C
authors.lastname: Rau
authors.forename: M
authors.initials: M
authors.lastname: Guenzi
authors.forename: F
authors.initials: F
authors.lastname: Zinzindohoué
authors.forename: A
authors.initials: A
authors.lastname: Berger
authors.forename: J-M
authors.initials: JM
authors.lastname: Chevallier
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D061214:Patient Safety; D011183:Postoperative Complications / Q000503:physiopathology; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D017211:Treatment Failure; D016896:Treatment Outcome; D015431:Weight Loss
keywords: Bariatric surgery; Gastric bypass; Longitudinal gastrectomy; Mini gastric bypass; Obesity; Sleeve gastrectomy