Roel Bolckmans1, Gustavo Arman2, Jacques Himpens2. 1. Department of Bariatric Surgery, AZ Sint-Blasius, Dendermonde, Belgium. roel_bolckmans@hotmail.com. 2. Department of Bariatric Surgery, AZ Sint-Blasius, Dendermonde, Belgium.
Abstract
BACKGROUND: There is a paucity on literature data related to conversion of Omega anastomosis gastric bypass (OAGB) to Roux-en-Y gastric bypass (RYGB). METHODS: This is a retrospective study. Records of all patients who underwent this conversion were analyzed. Additionally, patients were contacted to answer a questionnaire on their current clinical condition. RESULTS: Twenty-eight patients underwent laparoscopic conversion between September 2007 and June 2016. Indications were peritonitis in 7 patients (leaks after OAGB in 5, perforated marginal ulcer (MU) and blow-out remnant with concomitant leak in one patient each), anastomotic bleeding in one, bile reflux in 6, recalcitrant MU in 4, afferent loop syndrome in 6, postprandial vomiting in 2 (related to anastomotic stenosis and perianastomotic diverticulum, one each), and malnutrition and hypoglycemia both in 1. Thirty-day mortality was zero, complication rate (Clavien-Dindo grade III or more) 5% ((N = 1/20), abscess) when conversion was elective and 50.0% ((N = 4/8), all persisting leaks) when conversion was urgent. All 4 leaks persisting after conversion were successfully treated by endoscopic stenting, despite stent migration in 2 patients. Follow-up was available in 92.9%, for a mean time of 64.5 ± 30.1 months. Successful symptom relief (Likert score 4 or more) was noted for bile reflux and postprandial vomiting. Additionally, malnutrition was corrected. CONCLUSIONS: When indicated, conversion of OAGB to RYGB is a safe treatment strategy. In case conversion is performed for leak after OAGB, persisting subclinical leaks are frequent but can be efficiently addressed by endoscopic stenting.
BACKGROUND: There is a paucity on literature data related to conversion of Omega anastomosis gastric bypass (OAGB) to Roux-en-Y gastric bypass (RYGB). METHODS: This is a retrospective study. Records of all patients who underwent this conversion were analyzed. Additionally, patients were contacted to answer a questionnaire on their current clinical condition. RESULTS: Twenty-eight patients underwent laparoscopic conversion between September 2007 and June 2016. Indications were peritonitis in 7 patients (leaks after OAGB in 5, perforated marginal ulcer (MU) and blow-out remnant with concomitant leak in one patient each), anastomotic bleeding in one, bile reflux in 6, recalcitrant MU in 4, afferent loop syndrome in 6, postprandial vomiting in 2 (related to anastomotic stenosis and perianastomotic diverticulum, one each), and malnutrition and hypoglycemia both in 1. Thirty-day mortality was zero, complication rate (Clavien-Dindo grade III or more) 5% ((N = 1/20), abscess) when conversion was elective and 50.0% ((N = 4/8), all persisting leaks) when conversion was urgent. All 4 leaks persisting after conversion were successfully treated by endoscopic stenting, despite stent migration in 2 patients. Follow-up was available in 92.9%, for a mean time of 64.5 ± 30.1 months. Successful symptom relief (Likert score 4 or more) was noted for bile reflux and postprandial vomiting. Additionally, malnutrition was corrected. CONCLUSIONS: When indicated, conversion of OAGB to RYGB is a safe treatment strategy. In case conversion is performed for leak after OAGB, persisting subclinical leaks are frequent but can be efficiently addressed by endoscopic stenting.
Authors: Steve Eubanks; Christopher A Edwards; Nicole M Fearing; Archana Ramaswamy; Roger A de la Torre; Klaus J Thaler; Brent W Miedema; James S Scott Journal: J Am Coll Surg Date: 2008-05 Impact factor: 6.113
Authors: M Musella; A Susa; F Greco; M De Luca; E Manno; C Di Stefano; M Milone; R Bonfanti; G Segato; A Antonino; L Piazza Journal: Surg Endosc Date: 2013-08-28 Impact factor: 4.584
Authors: Nienke Slagter; Jonne Hopman; Anna G Altenburg; Loek J M de Heide; Ewoud H Jutte; Mirjam A Kaijser; Stefan L Damen; André P van Beek; Marloes Emous Journal: Obes Surg Date: 2021-01-26 Impact factor: 4.129
Authors: Mohammad Kermansaravi; Amir Hossein DavarpanahJazi; Shahab ShahabiShahmiri; Miguel Carbajo; Antonio Vitiello; Chetan D Parmar; Mario Musella Journal: Obes Surg Date: 2021-02-17 Impact factor: 4.129
Authors: Fernando Perez Galaz; Karen Moedano Rico; Maria Elena Lopez-Acosta; Issac Raffoul Cohen; Oscar Cervantes Gutierrez; Raul Cuevas Bustos; Felix Alejandro Perez Tristan; Marcos Jafif Cojab Journal: Int J Surg Case Rep Date: 2020-08-31