title: Indications for Revisions Following 630 Consecutive Laparoscopic Sleeve Gastrectomy Cases: Experience in a Single Accredited Center.
abstract: Bariatric surgery is the only proven and effective long-term treatment for morbid obesity, with laparoscopic sleeve gastrectomy (LSG) being the most commonly performed weight loss procedure in the USA. Despite its safety and efficacy, LSG's association with both de novo and pre-existing gastroesophageal reflux disease (GERD) remains controversial.
  
  
  
  Therefore, this retrospective study determined the incidence, indications, and outcomes of revisional surgery following LSG in adult patients at our institution from 2010 to 2014. Descriptive outcomes are reported due to the small sample size.
  
  
  
  Of the 630 LSGs performed, 481 patients were included in the analysis (mean age and BMI = 46.2 and 44.3, respectively; 79.5 % female; 82.3 % white). A total of 12/481 patients underwent conversion to a different bariatric procedure due to inadequate weight loss, GERD, or both. The 6/12 patients with GERD-related symptoms and failed medical management underwent conversion to Roux-en-Y gastric bypass (RYBG) following preoperative wireless Bravo pH monitoring (Given Imaging) to confirm the diagnosis objectively. The other 6/12 patients with inadequate weight loss received either RYBG or bilio-pancreatic diversion with duodenal switch (BPD/DS) based on personal choice. Overall, 9/12 patients underwent conversion to RYBG, and 3/12 underwent conversion to BPD/DS. Median time from the initial surgery to conversion was 27 months (range 17-41). Median operating room time was 168 min (range 130-268). Median length of stay was 48 h (range 24-72). The follow-up rate at 3 months was 100 % (12/12 patients).
  
  
  
  Our study showed that some patients may present following LSG with refractory GERD or inadequate weight loss, but that conversion to RYBG or BPD/DS may be done safely and effectively.
authors: Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, the Medical School of Temple University/St Luke's University Health Network, 1736 Hamilton Boulevard, Allentown, PA, 18104, USA. Maher.Elchaar@sluhn.org.
authors: Maher
authors: M
authors: El Chaar
authors: Research Institute, St Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA, 18105, USA.
authors: Jill
authors: J
authors: Stoltzfus
authors: Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, the Medical School of Temple University/St Luke's University Health Network, 1736 Hamilton Boulevard, Allentown, PA, 18104, USA.
authors: Leonardo
authors: L
authors: Claros
authors: Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, the Medical School of Temple University/St Luke's University Health Network, 1736 Hamilton Boulevard, Allentown, PA, 18104, USA.
authors: Maureen
authors: M
authors: Miletics
mesh_terms: D000328:Adult; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000601:surgery; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D015431:Weight Loss; D055815:Young Adult
keywords: Duodenal switch; Gastric bypass; Heartburn