title: Laparoscopic conversion of sleeve gastrectomy to a biliopancreatic diversion with duodenal switch or a Roux-en-Y gastric bypass due to weight loss failure: our algorithm.
abstract: BACKGROUND
  Failed sleeve gastrectomy (SG), defined by inadequate weight loss or weight regain, can be treated by a laparoscopic conversion to a biliopancreatic diversion with duodenal switch (DS) or a Roux-en-Y gastric bypass (RYGB). We report the outcomes of these procedures after SG failure.
  
  
  METHODS
  All patients who underwent DS (n=9) or RYGB (n=10) due to inadequate weight loss or weight regain between December 2006 and November 2012 after a failed SG were enrolled.
  
  
  RESULTS
  The mean pre-SG weight and body mass index (BMI) for the DS and RYGB patients were 143±36 kg and 51.5±11 kg/m2 and 120±26 kg and 44.5±5 kg/m2, respectively. The interval between the SG and the conversion to DS and to RYGB was 27±18 months and 36±17 months, respectively. The operation time and hospital stay were 191±64 minutes and 4.3±2.4 days for DS, and 111±37 minutes and 3.1±1.1 days for RYGB. At reoperation, the weight, BMI and percentage of excess weight loss (%EWL) were 113±22 kg, 43±6 kg/m2 and 28±16.5% and 107±27.5 kg, 40±5.7 kg/m2 and 25±12.7% (all P>.05), for the DS and RYGB, respectively. None of the patients were lost to follow-up. The post-DS weight, BMI, and %EWL were 84±19 kg, 30.7±7.4 kg/m2, and 80±40%. The post-RYGB weight, BMI, and %EWL were 81±21 kg, 30.2±4.8 kg/m2, and 65.5±34% (all P>.05).
  
  
  CONCLUSIONS
  DS and RYGB are feasible and effective operations after a failed SG. The DS yields a greater weight loss. The mechanism of failure should guide selection of the second procedure.
authors.affiliation: Department of Surgery Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel.
authors.forename: Idan
authors.initials: I
authors.lastname: Carmeli
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Inbal
authors.initials: I
authors.lastname: Golomb
authors.affiliation: Department of Surgery Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Sadot
authors.affiliation: Department of Surgery Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel.
authors.forename: Hanoch
authors.initials: H
authors.lastname: Kashtan
authors.affiliation: Department of Surgery Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel. Electronic address: keidar66@yahoo.com.
authors.forename: Andrei
authors.initials: A
authors.lastname: Keidar
mesh_terms: D000328:Adult; D000465:Algorithms; D015904:Biliopancreatic Diversion / Q000379:methods*; D061887:Conversion to Open Surgery / Q000379:methods; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D015431:Weight Loss / Q000502:physiology
keywords: Conversional bariatric surgery; Laparoscopic Roux-en-Y gastric bypass; Laparoscopic biliopancreatic diversion with duodenal switch; Laparoscopic sleeve gastrectomy failure