Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: an audit of 34 patients.
BACKGROUND
Weight loss failure and proton pomp inhibitor (PPI)-resistant gastroesophageal reflux diseases (GERD) after sleeve gastrectomy (SG) are frequently encountered.


OBJECTIVE
The aim of this study was to evaluate the efficacy and risks of SG conversion to Roux-en-Y gastric bypass (RYGB) in the case of weight loss failure or severe GERD.


METHODS
University hospitals.


METHODS
Between March 2007 and December 2014, 34 patients with history of SG underwent RYGP. A retrospective analysis of a prospectively collected database was undertaken.


RESULTS
Among 34 patients, 31 underwent revisional surgery for weight loss failure and 3 for PPI-resistant GERD. Six patients in the weight loss failure group had symptomatic GERD that was effectively treated with PPIs. The average body mass index (BMI) was 53±11 kg/m2 before SG. A laparoscopic approach was performed in 94% of patients. There was no postoperative mortality. Major adverse events (<90 days) occurred in 4 patients (11.7%). The mean length of stay was 6.7±2.8 days. At the time of revisional surgery, the mean BMI, percentage excess weight loss, and percentage weight loss were 44.7±9.8 kg/m2, 33.6±27.1%, and 16±9.7%, respectively, compared with 40.9±8.5 kg/m2, 63.1±36.2%, and 23.8±14% at 3 years. The GERD was resolved in all patients, allowing the cessation of PPI medication.


CONCLUSIONS
Laparoscopic conversion of SG to RYGB is feasible and it allows improvement in secondary weight loss and GERD, but at the cost of high morbidity.
AP-HP, Department of Digestive, Oncologic and Metabolic Surgery, Hôpital Ambroise Paré, Boulogne-Billancourt, France; UVSQ, UFR des sciences de la santé Simone Veil, 78180, Montigny-le-Bretonneux, France. Electronic address: tigran.poghosyan@aphp.fr.
Tigran
T
Poghosyan
Department of Digestive and Bariatric Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
Andrea
A
Lazzati
AP-HP, Department of Digestive, Oncologic and Metabolic Surgery, Hôpital Ambroise Paré, Boulogne-Billancourt, France; UVSQ, UFR des sciences de la santé Simone Veil, 78180, Montigny-le-Bretonneux, France.
David
D
Moszkowicz
Department of Digestive and Bariatric Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
Divya
D
Danoussou
AP-HP, Department of Digestive, Oncologic and Metabolic Surgery, Hôpital Ambroise Paré, Boulogne-Billancourt, France; UVSQ, UFR des sciences de la santé Simone Veil, 78180, Montigny-le-Bretonneux, France.
Karina
K
Vychnevskaia
Department of Digestive and Bariatric Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
Daniel
D
Azoulay
UVSQ, UFR des sciences de la santé Simone Veil, 78180, Montigny-le-Bretonneux, France; AP-HP, Department of Nutrition, Hôpital Ambroise Paré, Boulogne -Billancourt, France; INSERM UMS 011, Villejuif, France.
Sebastien
S
Czernichow
UVSQ, UFR des sciences de la santé Simone Veil, 78180, Montigny-le-Bretonneux, France; AP-HP, Department of Nutrition, Hôpital Ambroise Paré, Boulogne -Billancourt, France.
Claire
C
Carette
AP-HP, Department of Digestive, Oncologic and Metabolic Surgery, Hôpital Ambroise Paré, Boulogne-Billancourt, France; UVSQ, UFR des sciences de la santé Simone Veil, 78180, Montigny-le-Bretonneux, France.
Jean-Luc
JL
Bouillot
D000328:Adult; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000628:therapy; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017211:Treatment Failure; D015431:Weight Loss / Q000502:physiology
D054328:Proton Pump Inhibitors
Gastroesophageal reflux; Revisional surgery; Roux-en-Y gastric bypass; Sleeve gastrectomy; Weight loss failure