Short-term outcomes of sleeve gastrectomy conversion to R-Y gastric bypass: multi-center retrospective study

Cristian Eugeniu Boru, Francesco Greco, Piero Giustacchini, Marco Raffaelli, Gianfranco Silecchia

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Introduction: The outcomes of failed laparoscopic sleeve gastrectomies (LSG) converted to laparoscopic standard R-Y gastric bypass (LRYGB) in case of insufficient weight loss (IWL), weight regain (WR), and/or severe gastro-esophageal reflux disease (GERD) are scanty. Purpose: To evaluate incidence, indications, and short-term outcomes of LSG conversion to LRYGB in three bariatric centers. Methods: Patients operated between January 2012 and December 2016 by primary LSG, with mean follow-up of 24 months and converted to LRYGB for IWL, WR, and/or GERD, were retrospectively analyzed for demographics, operative details, perioperative complications, comorbidities evolution, and further WL. Results: Thirty patients (2.76%, 7 M/23 F, mean age 41 ± 10.1 years, initial mean BMI 46.9 ± 6.3 kg/m2) were successfully converted after a mean period of 33 ± 27.8 months for severe GERD (15 patients, 50%), GERD and IWL/WR (3 patients, 10%), and IWL/WR (12 patients, 40%). Surgical complications occurred in three patients (10%). Mean BMI at revision time was 36 ± 9 kg/m2, and 30.8 ± 5.2, 28 ± 4.9, and 28 ± 4.3 kg/m2 after 6, 12, and 24 months, respectively. Resolution of GERD was achieved in 83% of cases. Overall, postoperative satisfaction was reported by 96% of the cases, after mean follow-up of 24 ± 8.9 months. Conclusions: In high-volume centers, where strict criteria for patients’ selection for LSG are applied, the expected incidence of reoperations for “non-responder” (IWL/WR) or de novo or persistent severe GERD non-responder to medical treatment is low (< 3%). Conversion of “non-responder” LSG to LRYGB is effective for further WL and GERD remission at short term (2 years follow-up); however, a high postoperative complication rate was observed. Long-term multidisciplinary follow-up is mandatory to confirm data on WL durability and comorbidity control.

Original languageEnglish
Pages (from-to)473-479
Number of pages7
JournalLangenbeck's Archives of Surgery
Volume403
Issue number4
DOIs
Publication statusPublished - Jun 1 2018

Fingerprint

Esophageal Diseases
Gastric Bypass
Gastrectomy
Gastroesophageal Reflux
Retrospective Studies
Weight Loss
Weights and Measures
Comorbidity
Bariatrics
Incidence
Reoperation
Patient Selection
Demography

Keywords

  • Conversion
  • Gastric bypass
  • GERD
  • Insufficient weight loss
  • Outcomes
  • Sleeve gastrectomy failure
  • Weight regain

ASJC Scopus subject areas

  • Surgery

Cite this

Short-term outcomes of sleeve gastrectomy conversion to R-Y gastric bypass : multi-center retrospective study. / Boru, Cristian Eugeniu; Greco, Francesco; Giustacchini, Piero; Raffaelli, Marco; Silecchia, Gianfranco.

In: Langenbeck's Archives of Surgery, Vol. 403, No. 4, 01.06.2018, p. 473-479.

Research output: Contribution to journalArticle

Boru, Cristian Eugeniu ; Greco, Francesco ; Giustacchini, Piero ; Raffaelli, Marco ; Silecchia, Gianfranco. / Short-term outcomes of sleeve gastrectomy conversion to R-Y gastric bypass : multi-center retrospective study. In: Langenbeck's Archives of Surgery. 2018 ; Vol. 403, No. 4. pp. 473-479.
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abstract = "Introduction: The outcomes of failed laparoscopic sleeve gastrectomies (LSG) converted to laparoscopic standard R-Y gastric bypass (LRYGB) in case of insufficient weight loss (IWL), weight regain (WR), and/or severe gastro-esophageal reflux disease (GERD) are scanty. Purpose: To evaluate incidence, indications, and short-term outcomes of LSG conversion to LRYGB in three bariatric centers. Methods: Patients operated between January 2012 and December 2016 by primary LSG, with mean follow-up of 24 months and converted to LRYGB for IWL, WR, and/or GERD, were retrospectively analyzed for demographics, operative details, perioperative complications, comorbidities evolution, and further WL. Results: Thirty patients (2.76{\%}, 7 M/23 F, mean age 41 ± 10.1 years, initial mean BMI 46.9 ± 6.3 kg/m2) were successfully converted after a mean period of 33 ± 27.8 months for severe GERD (15 patients, 50{\%}), GERD and IWL/WR (3 patients, 10{\%}), and IWL/WR (12 patients, 40{\%}). Surgical complications occurred in three patients (10{\%}). Mean BMI at revision time was 36 ± 9 kg/m2, and 30.8 ± 5.2, 28 ± 4.9, and 28 ± 4.3 kg/m2 after 6, 12, and 24 months, respectively. Resolution of GERD was achieved in 83{\%} of cases. Overall, postoperative satisfaction was reported by 96{\%} of the cases, after mean follow-up of 24 ± 8.9 months. Conclusions: In high-volume centers, where strict criteria for patients’ selection for LSG are applied, the expected incidence of reoperations for “non-responder” (IWL/WR) or de novo or persistent severe GERD non-responder to medical treatment is low (< 3{\%}). Conversion of “non-responder” LSG to LRYGB is effective for further WL and GERD remission at short term (2 years follow-up); however, a high postoperative complication rate was observed. Long-term multidisciplinary follow-up is mandatory to confirm data on WL durability and comorbidity control.",
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AU - Raffaelli, Marco

AU - Silecchia, Gianfranco

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N2 - Introduction: The outcomes of failed laparoscopic sleeve gastrectomies (LSG) converted to laparoscopic standard R-Y gastric bypass (LRYGB) in case of insufficient weight loss (IWL), weight regain (WR), and/or severe gastro-esophageal reflux disease (GERD) are scanty. Purpose: To evaluate incidence, indications, and short-term outcomes of LSG conversion to LRYGB in three bariatric centers. Methods: Patients operated between January 2012 and December 2016 by primary LSG, with mean follow-up of 24 months and converted to LRYGB for IWL, WR, and/or GERD, were retrospectively analyzed for demographics, operative details, perioperative complications, comorbidities evolution, and further WL. Results: Thirty patients (2.76%, 7 M/23 F, mean age 41 ± 10.1 years, initial mean BMI 46.9 ± 6.3 kg/m2) were successfully converted after a mean period of 33 ± 27.8 months for severe GERD (15 patients, 50%), GERD and IWL/WR (3 patients, 10%), and IWL/WR (12 patients, 40%). Surgical complications occurred in three patients (10%). Mean BMI at revision time was 36 ± 9 kg/m2, and 30.8 ± 5.2, 28 ± 4.9, and 28 ± 4.3 kg/m2 after 6, 12, and 24 months, respectively. Resolution of GERD was achieved in 83% of cases. Overall, postoperative satisfaction was reported by 96% of the cases, after mean follow-up of 24 ± 8.9 months. Conclusions: In high-volume centers, where strict criteria for patients’ selection for LSG are applied, the expected incidence of reoperations for “non-responder” (IWL/WR) or de novo or persistent severe GERD non-responder to medical treatment is low (< 3%). Conversion of “non-responder” LSG to LRYGB is effective for further WL and GERD remission at short term (2 years follow-up); however, a high postoperative complication rate was observed. Long-term multidisciplinary follow-up is mandatory to confirm data on WL durability and comorbidity control.

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KW - Outcomes

KW - Sleeve gastrectomy failure

KW - Weight regain

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