One-stage conversion of Roux-en-Y gastric bypass to a modified biliopancreatic diversion with duodenal switch using a hybrid sleeve concept.
BACKGROUND
Insufficient weight loss (percentage of excess weight loss [%EWL]<50%) is observed in approximately 20% of patients after Roux-en-Y gastric bypass (RYGB). Surgical revision can be performed by various procedures including malabsorptive techniques. Conversion to a biliopancreatic diversion with duodenal switch (BPD/DS) remains a complex technique which cannot always be performed as a one-stage procedure.


OBJECTIVE
This study evaluates the conversion of RYGB to BPD/DS using a novel gastric reconstruction technique based on a "hybrid sleeve" using the existing gastrojejunal anastomosis of the RYGB.


METHODS
All the procedures were performed at a private hospital.


METHODS
The consecutive patients who were eligible for conversion since 2010 were reviewed; eligibility included %EWL≤50% and normal gastric pouch. The gastrojejunal anastomosis of the RYGB was untouched and the gastric fundus was resected. The gastric continuity was restored by an anastomosis between a short segment of the alimentary limb and the gastric antrum. A standard BPD/DS was then performed without restoration of the jejunal continuity.


RESULTS
Fourteen patients were converted to BPD/DS for a mean body mass index (BMI) of 44.3±6.0 kg/m2, a mean %EWL of 33.4%, and a percentage of total weight loss (%TWL) of 15.3±11.7%. The BMI before RYGB was 54.4±13.1 kg/m2, with half of the patients being super-obese. All but 3 conversions were completed as a single stage and laparoscopically in a mean of 177 minutes. The 30-day complication rate was 28.5%. No patient was lost to follow-up over a mean 25.8 months and the BMI of the 12 patients with a follow-up≥3 months is 33.2±7.2 kg/m2. With reference to the initial weight of the patients, the mean %EWL is 73.5% and %TWL is 37.6±16.0%. On average, patients benefited from a 21.1% TWL through the conversion of their RYGB.


CONCLUSIONS
This procedure allows for an easier conversion of RYGB to BPD/DS and appears to be the most effective procedure for resuming weight loss. Nutritional consequences and weight loss are similar to the primary BPD/DS results. However, the benefits and risks must be carefully assessed according to the definition of weight loss failure.
Société de Chirurgie Viscérale, Clinique de l'Anjou, Angers, France. Electronic address: ptopart@gmail.com.
Philippe
P
Topart
Société de Chirurgie Viscérale, Clinique de l'Anjou, Angers, France.
Guillaume
G
Becouarn
D015904:Biliopancreatic Diversion / Q000379:methods*; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D004386:Duodenum / Q000601:surgery*; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D009767:Obesity, Morbid / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D015431:Weight Loss / Q000502:physiology
Conversion; Duodenal switch; Gastric bypass; Hybrid sleeve