title: Laparoscopic conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: indications and preliminary results.
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (SG) has gained popularity as a standalone procedure. However, long-term complications are reported, mainly weight loss failure and gastroesophageal reflux disease (GERD). Therefore, demand for revisional surgery is rising.
  
  
  OBJECTIVE
  The aim of this study was to report preliminary results within the 2 main indications for laparoscopic conversion of SG to Roux-en-Y gastric bypass (RYGB).
  
  
  METHODS
  University Hospital, France.
  
  
  METHODS
  Data from all patients who underwent laparoscopic conversion from SG to RYGB were retrospectively analyzed as to indications for revisional surgery, weight loss, and complications.
  
  
  RESULTS
  Forty patients underwent conversion, 29 cases (72.5%) for weight loss failure and 11 cases for refractory GERD (27.5%). The mean interval from SG to RYGB was 32.6 months (range 8-113). Revisional surgery was attempted by laparoscopy in all cases, and conversion to laparotomy was necessary in 3 patients (7.5%). Mean length of follow-up was 18.6 months (range 9-60) after conversion. Follow-up rate was 100%. Mean percent total weight loss and percent excess weight loss were 34.7% and 64%, respectively, when calculated from weight before SG. Remission rate for GERD was 100%. Improvement was observed for all co-morbidities after conversion. There was no immediate postoperative mortality. The postoperative complication rate was 16.7%. According to the Clavien-Dindo classification, there were 5 grade II and 2 grade IIIa complications.
  
  
  CONCLUSIONS
  Laparoscopic conversion of SG to RYGB is safe and feasible. In the short term, it appears to be effective in treating GERD and inducing significant additional weight loss and improvement of co-morbidities.
authors.affiliation: Digestive Center, Centre Hospitalier Universitaire of Nice, Nice, France; Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, Hepatic Complications in Obesity, Nice, France; Faculty of Medecine, University of Nice-Sophia-Antipolis, Nice, France.
authors.forename: Antonio
authors.initials: A
authors.lastname: Iannelli
authors.affiliation: Digestive Center, Centre Hospitalier Universitaire of Nice, Nice, France. Electronic address: dr.debs@hotmail.com.
authors.forename: Tarek
authors.initials: T
authors.lastname: Debs
authors.affiliation: Digestive Center, Centre Hospitalier Universitaire of Nice, Nice, France.
authors.forename: Francesco
authors.initials: F
authors.lastname: Martini
authors.affiliation: Digestive Center, Centre Hospitalier Universitaire of Nice, Nice, France; Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, Hepatic Complications in Obesity, Nice, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Benichou
authors.affiliation: Digestive Center, Centre Hospitalier Universitaire of Nice, Nice, France.
authors.forename: Imed
authors.initials: I
authors.lastname: Ben Amor
authors.affiliation: Digestive Center, Centre Hospitalier Universitaire of Nice, Nice, France; Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, Hepatic Complications in Obesity, Nice, France; Faculty of Medecine, University of Nice-Sophia-Antipolis, Nice, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Gugenheim
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D015390:Gastric Bypass / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D015431:Weight Loss / Q000502:physiology; D055815:Young Adult
keywords: Gastrooesophageal reflux; Revisional surgery; Roux-en-Y gastric bypass; Sleeve gastrectomy; Weight loss failure