Cullen O Carter1, Adolfo Z Fernandez2, Stephen S McNatt2, Myron S Powell2. 1. Department of Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina. Electronic address: cullencarter@gmail.com. 2. Department of Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina.
Abstract
BACKGROUND: Complications after gastric bypass (RYGB) are well documented. Reversal of RYGB is indicated in select cases but can lead to weight gain. Conversion from RYGB to sleeve gastrectomy (SG) has been proposed for correction of complications of RYGB without associated weight gain. However, little is known about outcomes after this procedure. OBJECTIVES: To examine outcomes after conversion from RYGB to SG. SETTING: University hospital. METHODS: A retrospective study of patients who underwent RYGB to SG conversion was undertaken. RESULTS: Twelve patients underwent RYGB to SG conversion for refractory marginal ulceration, stricture, dumping, gastrogastric fistula, hypoglycemia, and failed weight loss. No deaths occurred. Four patients experienced 7 major complications, including portal vein thrombosis, bleeding, pancreatic leak, pulmonary embolus, seroma, anastomotic leak, and stricture. Two required reoperation, and 6 were readmitted within 30 days. Four required nasoenteric feeding postoperatively because of prolonged nausea. The complication of RYGB resolved in 11 of 12 patients. At 14.7 months, change in body mass index for all patients was a decrease of 2.2 kg/m(2). In 5 patients with morbid obesity at conversion, the change in body mass index was a decrease of 6.4 kg/m(2) at 19 months. CONCLUSIONS: Laparoscopic conversion from RYGB to SG is successful in resolving certain complications of RYGB and does not result in short-term weight gain. However, conversion has a high rate of major complications as well as a high rate of readmission and need for supplemental nutrition. Although conversion to SG may be appropriate in carefully-selected patients, other options for patients with severe chronic complications after RYGB should be considered.
BACKGROUND: Complications after gastric bypass (RYGB) are well documented. Reversal of RYGB is indicated in select cases but can lead to weight gain. Conversion from RYGB to sleeve gastrectomy (SG) has been proposed for correction of complications of RYGB without associated weight gain. However, little is known about outcomes after this procedure. OBJECTIVES: To examine outcomes after conversion from RYGB to SG. SETTING: University hospital. METHODS: A retrospective study of patients who underwent RYGB to SG conversion was undertaken. RESULTS: Twelve patients underwent RYGB to SG conversion for refractory marginal ulceration, stricture, dumping, gastrogastric fistula, hypoglycemia, and failed weight loss. No deaths occurred. Four patients experienced 7 major complications, including portal vein thrombosis, bleeding, pancreatic leak, pulmonary embolus, seroma, anastomotic leak, and stricture. Two required reoperation, and 6 were readmitted within 30 days. Four required nasoenteric feeding postoperatively because of prolonged nausea. The complication of RYGB resolved in 11 of 12 patients. At 14.7 months, change in body mass index for all patients was a decrease of 2.2 kg/m(2). In 5 patients with morbid obesity at conversion, the change in body mass index was a decrease of 6.4 kg/m(2) at 19 months. CONCLUSIONS: Laparoscopic conversion from RYGB to SG is successful in resolving certain complications of RYGB and does not result in short-term weight gain. However, conversion has a high rate of major complications as well as a high rate of readmission and need for supplemental nutrition. Although conversion to SG may be appropriate in carefully-selected patients, other options for patients with severe chronic complications after RYGB should be considered.
Authors: Emidio Scarpellini; Joris Arts; George Karamanolis; Anna Laurenius; Walter Siquini; Hidekazu Suzuki; Andrew Ukleja; Andre Van Beek; Tim Vanuytsel; Serhat Bor; Eugene Ceppa; Carlo Di Lorenzo; Marloes Emous; Heinz Hammer; Per Hellström; Martine Laville; Lars Lundell; Ad Masclee; Patrick Ritz; Jan Tack Journal: Nat Rev Endocrinol Date: 2020-05-26 Impact factor: 43.330