title: Conversion from gastric bypass to sleeve gastrectomy for complications of gastric bypass.
abstract: BACKGROUND
  Complications after gastric bypass (RYGB) are well documented. Reversal of RYGB is indicated in select cases but can lead to weight gain. Conversion from RYGB to sleeve gastrectomy (SG) has been proposed for correction of complications of RYGB without associated weight gain. However, little is known about outcomes after this procedure.
  
  
  OBJECTIVE
  To examine outcomes after conversion from RYGB to SG.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  A retrospective study of patients who underwent RYGB to SG conversion was undertaken.
  
  
  RESULTS
  Twelve patients underwent RYGB to SG conversion for refractory marginal ulceration, stricture, dumping, gastrogastric fistula, hypoglycemia, and failed weight loss. No deaths occurred. Four patients experienced 7 major complications, including portal vein thrombosis, bleeding, pancreatic leak, pulmonary embolus, seroma, anastomotic leak, and stricture. Two required reoperation, and 6 were readmitted within 30 days. Four required nasoenteric feeding postoperatively because of prolonged nausea. The complication of RYGB resolved in 11 of 12 patients. At 14.7 months, change in body mass index for all patients was a decrease of 2.2 kg/m(2). In 5 patients with morbid obesity at conversion, the change in body mass index was a decrease of 6.4 kg/m(2) at 19 months.
  
  
  CONCLUSIONS
  Laparoscopic conversion from RYGB to SG is successful in resolving certain complications of RYGB and does not result in short-term weight gain. However, conversion has a high rate of major complications as well as a high rate of readmission and need for supplemental nutrition. Although conversion to SG may be appropriate in carefully-selected patients, other options for patients with severe chronic complications after RYGB should be considered.
authors.affiliation: Department of Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina. Electronic address: cullencarter@gmail.com.
authors.forename: Cullen O
authors.initials: CO
authors.lastname: Carter
authors.affiliation: Department of Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina.
authors.forename: Adolfo Z
authors.initials: AZ
authors.lastname: Fernandez
authors.affiliation: Department of Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina.
authors.forename: Stephen S
authors.initials: SS
authors.lastname: McNatt
authors.affiliation: Department of Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina.
authors.forename: Myron S
authors.initials: MS
authors.lastname: Powell
mesh_terms: D000328:Adult; D004377:Dumping Syndrome / Q000209:etiology / Q000601:surgery; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D009767:Obesity, Morbid / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D015430:Weight Gain / Q000502:physiology
keywords: Bariatric complications; Bariatric surgery; Conversion; Failed weight loss; Gastric bypass; Intractable dumping syndrome; Revisional bariatric surgery; Sleeve gastrectomy