title: Revisional single-anastomosis gastric bypass for a failed restrictive procedure: 5-year results.
abstract: BACKGROUND
  Long-term outcomes of revisional laparoscopic single anastomosis-gastric bypass for a failed restrictive procedure (rSAGB) have not been analyzed.
  
  
  OBJECTIVE
  To assess 5-year outcomes of rSAGB compared with 5-year outcomes of primary SAGB (pSAGB).
  
  
  METHODS
  University public hospital, France.
  
  
  METHODS
  One hundred twenty-six patients who underwent SAGB between October 2006 and October 2008 were included in this retrospective study. rSAGB was defined as SAGB performed after failure of a first restrictive procedure. Five-year outcomes of each procedure regarding mortality, morbidity (i.e., Clavien-Dindo score), weight loss (change in body mass index [BMI] and percentage of excess BMI loss [%EBMIL]), co-morbidities remission, and Gastrointestinal Quality of Life Index (GIQLI) score, were assessed.
  
  
  RESULTS
  Thirty patients (24%) who had prior restrictive bariatric surgery (including 22 laparoscopic adjustable gastric bandings, 4 vertical banded gastroplasties, and 4 sleeve gastrectomies) underwent conversion to rSAGB. Ninety-six patients (76%) underwent primary SAGB (pSAGB group). Both groups were comparable in age, gender, BMI, and preoperative co-morbidities. Preoperative mean BMI of the rSAGB group was 45.5±7 kg/m(2). There were no deaths and the major complications rate was 10%. No increase in morbidity was found between the 2 groups. Two patients required conversion to RYGB after rSAGB because of intractable biliary reflux. At 5 years, mean BMI was 32 kg/m(2) and mean %EBMIL was 66% after rSAGB; no significant differences were found compared with pSAGB (BMI = 31 kg/m(2), %EBMIL = 73%). Co-morbidities and remission rates were statically similar. Overall, GIQLI score was significantly lower in the rSAGB group (104.1±17.6 versus 112.5±16.8, P = .025). Significant differences were found in "upper gastrointestinal symptoms" and "psychological" scores.
  
  
  CONCLUSIONS
  At 5 years, rSAGB for a failed restrictive procedure was safe and effective, but quality of life and upper gastrointestinal function were lower compared with pSAGB.
authors.affiliation: Department of Digestive Surgery, Hôpital Européen Georges Pompidou, Paris, France. Electronic address: matthieu_bruz@yahoo.fr.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Bruzzi
authors.affiliation: Department of Digestive Surgery, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Thibault
authors.initials: T
authors.lastname: Voron
authors.affiliation: Department of Digestive Surgery, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Zinzindohoue
authors.affiliation: Department of Digestive Surgery, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Berger
authors.affiliation: Department of Digestive Surgery, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Douard
authors.affiliation: Department of Digestive Surgery, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Chevallier
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D015390:Gastric Bypass / Q000379:methods*; D015391:Gastroplasty / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Failed restrictive procedure; Mini-gastric bypass; Morbid obesity; Revision; Single-anastomosis gastric bypass; Weight loss