title: Roux-en-Y gastric bypass for the treatment of severe complications after omega-loop gastric bypass.
abstract: BACKGROUND
  Omega-loop gastric bypass (OLGB) may be associated with severe complications, including anastomotic leak, refractory ulcer or stenosis, undernutrition, and disabling digestive disorders (chronic diarrhea, steatorrhea, bile reflux, and vomiting). OLGB conversion to Roux-en-Y gastric bypass (RYGB) was suggested to treat these complications.
  
  
  OBJECTIVE
  To evaluate the efficacy and risk of severe complications after OLGB conversion to RYGB.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Retrospective analysis between October 2011 and June 2016.
  
  
  RESULTS
  Seventeen patients underwent OLGB conversion to RYGB. Fourteen patients (82%) presented at least 1 disabling digestive disorder. Before conversion, 10 patients (58.8%) received nutritional support for undernutrition. There was no postoperative mortality. Seven patients (41.1%) developed major adverse events (<90 d). At conversion, the average weight, body mass index, and percent of excess weight loss for the population without undernutrition (n = 7) were 103.7±24 kg, 38.7±6.8 kg/m², and 37%±33%, respectively. These values were 85±18.3 kg, 30.6±4.7 kg/m², and 73.3%±21.5%, respectively, at 2 years. In patients with undernutrition (n = 10), the average weight, body mass index, and percent of excess weight loss were 52.2±16.5 kg, 18.7±5.9 kg/m², and 149.3%±46.5%, respectively, before nutritional support and 58.9±14.7 kg, 21.1±5.2 kg/m², and 132.7%±39.1%, respectively, at revisional surgery. At 2 years the values were 71±5.6 kg, 24.3±2.2 kg/m², and 104.6%±15.2%, respectively. The patients experienced significant improvements in hypoalbuminemia, anemia, and vitamin/trace element deficiencies. The disabling digestive disorders resolved in 85% of patients.
  
  
  CONCLUSIONS
  The conversion of OLGB to RYGB for severe complications allows for weight correction in patients with undernutrition, reduces disabling digestive disorders, and improves the nutritional status of patients. However, the conversion is associated with high morbidity.
authors.affiliation: Department of Digestive, Oncologic and Metabolic Surgery, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Université Paris Saclay, UFR des sciences de la santé Simone Veil, Montigny-le-Bretonneux, France. Electronic address: tigran.poghosyan@aphp.fr.
authors.forename: Tigran
authors.initials: T
authors.lastname: Poghosyan
authors.affiliation: Department of Digestive, Oncologic and Metabolic Surgery, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Université Paris Saclay, UFR des sciences de la santé Simone Veil, Montigny-le-Bretonneux, France.
authors.forename: Clementine
authors.initials: C
authors.lastname: Caille
authors.affiliation: Department of Digestive, Oncologic and Metabolic Surgery, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Université Paris Saclay, UFR des sciences de la santé Simone Veil, Montigny-le-Bretonneux, France.
authors.forename: David
authors.initials: D
authors.lastname: Moszkowicz
authors.affiliation: Université Paris Saclay, UFR des sciences de la santé Simone Veil, Montigny-le-Bretonneux, France; Department of Nutrition, Hôpital Raymond Poincaré, Garches, France.
authors.forename: Mouna
authors.initials: M
authors.lastname: Hanachi
authors.affiliation: Department of Nutrition, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Carette
authors.affiliation: Department of Digestive, Oncologic and Metabolic Surgery, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Université Paris Saclay, UFR des sciences de la santé Simone Veil, Montigny-le-Bretonneux, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Bouillot
mesh_terms: D000328:Adult; D000740:Anemia / Q000209:etiology / Q000601:surgery; D004066:Digestive System Diseases / Q000209:etiology* / Q000601:surgery; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D034141:Hypoalbuminemia / Q000209:etiology / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects*; D008286:Malabsorption Syndromes / Q000209:etiology / Q000601:surgery; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000601:surgery; D015596:Nutrition Assessment; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000706:statistics & numerical data; D016896:Treatment Outcome; D015430:Weight Gain / Q000502:physiology; D015431:Weight Loss / Q000502:physiology
keywords: Nutritional complication; Omega loop gastric bypass; Revisional surgery; Roux-en-Y gastric bypass; Surgical complication