Shlomi Rayman1,2, Dan Assaf3, Carmil Azran4, Gideon Sroka5,6, Ahmad Assalia7, Nahum Beglaibter8, Ram Elazary9, Shai Meron Eldar10, Orly Romano-Zelekha11, David Goitein3,12. 1. Department of Surgery C, Chaim Sheba Medical Center, 2 Sheba Rd., 52610, Ramat Gan, Israel. shlomirayman@gmail.com. 2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. shlomirayman@gmail.com. 3. Department of Surgery C, Chaim Sheba Medical Center, 2 Sheba Rd., 52610, Ramat Gan, Israel. 4. Bariatric Center, Herzliya Medical Center, 7 Ramat Yam St, 4685107, Herzliya, Israel. 5. Department of General Surgery, Bnai-Zion Medical Center, Haifa, Israel. 6. Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel. 7. Department of General Surgery, Rambam Health Care Campus and the Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. 8. Department of Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus, 91240, Jerusalem, Israel. 9. Department of Surgery, Hadassah-Hebrew University Medical Center, Ein-Kerem Campus, Jerusalem, Israel. 10. Department of General Surgery, The Tel-Aviv Sourasky Medical Center of Medicine, Tel Aviv University, Tel-Aviv-Yafo, Israel. 11. Israel Center for Disease Control, Ministry of Health, Tel Hashomer Campus, 56261, Ramat Gan, Israel. 12. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Abstract
INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) is the most popular bariatric procedure performed worldwide. However, many patients undergo secondary surgery due to either weight-related and complication-related reasons or both. Conversional options vary with one-anastomosis gastric bypass (OAGB) and Roux-n-Y gastric bypass (RYGB) being the most common. The aim of the study was to assess the safety and efficacy of converting failed LSG to either OAGB or RYGB, and compare weight-related results and post-conversion complications. METHODS: Retrospective review of hospital records of patients who underwent conversion from LSG to either RYGB or OAGB due to insufficient weight loss or weight regain in 7 bariatric centers between 2013 and 2019. Data retrieved included demographics, anthropometrics, comorbidities, indication for conversion, conversion type, complications, and weight loss. RESULTS: During the study period, 396 patients were included in the study. Eighty-four (21%) patients were lost to follow-up. RYGB and OAGB were performed in 119 and 144 patients, respectively. Mean age and body mass index (BMI) at revision were 44.2 years (range 19-72) and 40.6 ± 5.9 kg/m2 (range 35-71), respectively. Of these, 191 (73%) were female. Percent total body weight loss (%TWL) was 16% ± 1% for the RYGB group vs. 23% ± 12% for the OAGB group (p = 0.0007) at a median follow-up of 29 months (range 7-78 months) following conversion. Gastroesophageal reflux disease (GERD) was significantly higher 1 year following conversion to OAGB vs. RYGB occurring in 25 (17.4%) and 9 (7.6%) patients, respectively (p = 0.018). CONCLUSIONS: Conversion of LSG to OAGB, compared to RYGB, results in increased weight loss but a higher rate of GERD and potential nutritional deficiencies.
INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) is the most popular bariatric procedure performed worldwide. However, many patients undergo secondary surgery due to either weight-related and complication-related reasons or both. Conversional options vary with one-anastomosis gastric bypass (OAGB) and Roux-n-Y gastric bypass (RYGB) being the most common. The aim of the study was to assess the safety and efficacy of converting failed LSG to either OAGB or RYGB, and compare weight-related results and post-conversion complications. METHODS: Retrospective review of hospital records of patients who underwent conversion from LSG to either RYGB or OAGB due to insufficient weight loss or weight regain in 7 bariatric centers between 2013 and 2019. Data retrieved included demographics, anthropometrics, comorbidities, indication for conversion, conversion type, complications, and weight loss. RESULTS: During the study period, 396 patients were included in the study. Eighty-four (21%) patients were lost to follow-up. RYGB and OAGB were performed in 119 and 144 patients, respectively. Mean age and body mass index (BMI) at revision were 44.2 years (range 19-72) and 40.6 ± 5.9 kg/m2 (range 35-71), respectively. Of these, 191 (73%) were female. Percent total body weight loss (%TWL) was 16% ± 1% for the RYGB group vs. 23% ± 12% for the OAGB group (p = 0.0007) at a median follow-up of 29 months (range 7-78 months) following conversion. Gastroesophageal reflux disease (GERD) was significantly higher 1 year following conversion to OAGB vs. RYGB occurring in 25 (17.4%) and 9 (7.6%) patients, respectively (p = 0.018). CONCLUSIONS: Conversion of LSG to OAGB, compared to RYGB, results in increased weight loss but a higher rate of GERD and potential nutritional deficiencies.
Authors: Karl Peter Rheinwalt; Sandra Schipper; Andreas Plamper; Patrick Hamid Alizai; Jonel Trebicka; Maximilian Joseph Brol; Andreas Kroh; Sophia Schmitz; Chetan Parmar; Ulf Peter Neumann; Tom Florian Ulmer Journal: World J Surg Date: 2022-01-05 Impact factor: 3.352