Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass

• Published in: Obesity surgery Vol. 28; no. 12; pp. 3843 - 3850
• Main Authors: Landreneau, Joshua P., Strong, Andrew T., Rodriguez, John H., Aleassa, Essa M., Aminian, Ali, Brethauer, Stacy, Schauer, Philip R., Kroh, Matthew D.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2018; Springer Nature B.V
• Subjects: Laparoscopy; Medicine; Medicine & Public Health; Original Contributions; Surgery; Laparoscopy; Roux-en-Y gastric bypass; Revisional surgery; Bariatric surgery; Sleeve gastrectomy
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-018-3435-1

Introduction A subset of patients undergoing laparoscopic sleeve gastrectomy (SG) require eventual conversion to Roux-en-Y gastric bypass (RYGB) due to complications from SG or to enhance weight loss. The aim of this study is to characterize the indications for conversion and perioperative outcomes in a large cohort of these patients at a single institution. Methods Patients who underwent revisional surgery to convert SG to RYGB at our institution from January 2008 through January 2017 were retrospectively reviewed. Results Eighty-nine patients with previous SG underwent conversion to RYGB as part of a planned two-stage approach to gastric bypass ( n  = 36), for weight recidivism ( n  = 11), or for complications related to SG ( n  = 42). Complications from SG that warranted conversion included refractory GERD (40.5%), sleeve stenosis (31.0%), gastrocutaneous (16.7%), or gastropleural (7.1%) fistula, and gastric torsion (4.1%). The mean (SD) age was 47.2 years (11.4 years) and median BMI at the time of revision was 43.2 kg/m 2 . A laparoscopic approach was successfully completed in 76 patients (85.4%), with an additional of four completed robotically (4.5%). The median length of stay was 3 days. Twenty-eight patients (31.5%) had complications which included surgical site infection (20.2%), re-operation (6.7%), anastomotic stricture (3.4%), and one pulmonary embolism. There were no mortalities with a median follow-up of 15 months. Conclusions Conversion of SG to RYGB is safe and technically feasible when performed for complications of SG or to enhance weight loss. This operation can be successfully performed laparoscopically with a low rate of conversion and reasonable complication profile.