title: Revision of primary sleeve gastrectomy to Roux-en-Y gastric bypass: indications and outcomes from a high-volume center.
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (SG) has become an accepted primary bariatric operation. Like other bariatric operations, inadequate weight loss and complications have been reported.
  
  
  OBJECTIVE
  The aim of this study was to assess the indications and outcomes of revision of SG to laparoscopic Roux-en-Y gastric bypass (RYGB) at a single community hospital.
  
  
  METHODS
  Community hospital, United States.
  
  
  METHODS
  Retrospective review of a prospectively collected database identifying SG operations done from February 2009 to June 2014. All patients who underwent revision from SG to RYGB were studied.
  
  
  RESULTS
  Forty-eight patients underwent revision of SG to RYGB. Mean time to revision was 26 months (range, 2-60 mo) and mean follow up after RYGB was 20 months (range, 4-48 mo). Indications for revision were reflux (n = 14), inadequate weight loss (n = 11), reflux and inadequate weight loss (n = 16), stricture (n = 4), chronic leak (n = 1), and recurrent diabetes and reflux (n = 2). Reflux symptoms resolved in 96% of patients after revision, and hiatal hernias were repaired in 50% of patients. Percentage total weight loss at 3, 6, 12, 24, and 36 months was 9.0%, 12.9%, 15.7%, 13.3%, and 6.5%, respectively. The overall rate of complication was 31%. There were no mortalities.
  
  
  CONCLUSIONS
  Revision of SG to RYGB is a potentially effective means of treating SG complications, particularly reflux. Reflux was the most common indication for revision and was often associated with a hiatal hernia. Further studies will be necessary to evaluate the long-term maintenance of additional weight loss after revision of SG to RYGB.
authors.affiliation: Department of Bariatric Surgery, Kaiser Permanente, West Los Angeles, CA. Electronic address: bcsurgeon2001@yahoo.com.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Casillas
authors.affiliation: Department of Bariatric Surgery, Kaiser Permanente, West Los Angeles, CA.
authors.forename: Scott S
authors.initials: SS
authors.lastname: Um
authors.affiliation: Department of Bariatric Surgery, Kaiser Permanente, West Los Angeles, CA.
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Zelada Getty
authors.affiliation: Department of Bariatric Surgery, Kaiser Permanente, West Los Angeles, CA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Sachs
authors.affiliation: Department of Bariatric Surgery, Kaiser Permanente, West Los Angeles, CA.
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery; D006551:Hernia, Hiatal / Q000209:etiology; D006764:Hospitals, Community; D061847:Hospitals, High-Volume; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult
keywords: Revisional bariatric surgery; Roux-en-Y gastric bypass; Sleeve gastrectomy