title: Laparoscopic revision of Roux-en-Y gastric bypass to sleeve gastrectomy: A ray of hope for failed Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Roux-en-Y gastric bypass (RYGB) is the most commonly performed bariatric operation across the world, but sometimes revision is necessary. Inadequate weight loss, weight regain, and complications such as dumping syndrome are common reasons for revision. We report the 1-year outcomes of five patients who underwent laparoscopic conversion of RYGB to sleeve gastrectomy during surgical revision.
  
  
  METHODS
  Mean age was 38.8 ± 9.1 years. Mean BMI at primary surgery was 57.9 ± 8.1 kg/m(2) . Two patients were diabetic and sleep apneic. One was hypertensive. All patients underwent a RYGB as the primary weight loss procedure. Mean weight loss was 36.8 ± 8.6 kg (excess weight loss  = 39.8 ± 14.9%) at 2 years. At the end of 5 years, these patients regained 10.9 ± 4.1 kg (31.5 ± 13.6% of excess weight loss). Primary indications for revision surgery were failure to lose weight, weight regain, and intractable dumping syndrome. Mean duration between primary and revision surgery was 6.2 ± 1.1 years. RYGB was converted to sleeve gastrectomy as a first stage in all cases.
  
  
  RESULTS
  Mean duration of revision surgery was 120.0 ± 15.5 min. Mean blood loss was 70 ± 50 mL. One year after revision surgery, a mean weight loss of 21.5 ± 10.5 kg was achieved (mean excess weight loss = 35.8 ± 8.8%). Two patients with type 2 diabetes mellitus and the one with hypertension achieved remission. Dumping was resolved. There were no complications.
  
  
  CONCLUSIONS
  Laparoscopic conversion of RYGB to sleeve gastrectomy as a first stage may be considered as an additional option in the armamentarium of revision procedures after RYGB.
authors.affiliation: Centre for Obesity and Digestive Surgery, Mumbai, India.|Department of Bariatric and Metabolic Surgery, Institute of Minimally Invasive Surgical Sciences and Research Centre, Saifee Hospital, Mumbai, India.
authors.forename: Muffazal
authors.initials: M
authors.lastname: Lakdawala
authors.affiliation: Centre for Obesity and Digestive Surgery, Mumbai, India.|Gading Pluit Hospital, Kelapa Gading, Indonesia.
authors.forename: Peter
authors.initials: P
authors.lastname: Limas
authors.affiliation: Centre for Obesity and Digestive Surgery, Mumbai, India.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Dhar
authors.affiliation: Centre for Obesity and Digestive Surgery, Mumbai, India.
authors.forename: Carlyne
authors.initials: C
authors.lastname: Remedios
authors.affiliation: Centre for Obesity and Digestive Surgery, Mumbai, India.
authors.forename: Neha
authors.initials: N
authors.lastname: Dhulla
authors.affiliation: Centre for Obesity and Digestive Surgery, Mumbai, India.|Department of Bariatric and Metabolic Surgery, Institute of Minimally Invasive Surgical Sciences and Research Centre, Saifee Hospital, Mumbai, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Sood
authors.affiliation: Centre for Obesity and Digestive Surgery, Mumbai, India.|Department of Bariatric and Metabolic Surgery, Institute of Minimally Invasive Surgical Sciences and Research Centre, Saifee Hospital, Mumbai, India.
authors.forename: Aparna Govil
authors.initials: AG
authors.lastname: Bhasker
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D015390:Gastric Bypass; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation; D017211:Treatment Failure; D015431:Weight Loss
keywords: Bypass to sleeve; dumping syndrome; weight regain