Eileen Roach1,2,3, Simon Laplante4,5, Shannon Stogryn4,5, Azusa Maeda4, Timothy Jackson4,5, Allan Okrainec4,5. 1. Division of General Surgery, University Health Network, Toronto, ON, Canada. eileen.roach@uhn.ca. 2. Department of Surgery, University of Toronto, Toronto, ON, Canada. eileen.roach@uhn.ca. 3. Division of General Surgery, Toronto Western Hospital, 8MP-325. 399 Bathurst St., Toronto, ON, M5T 2S8, Canada. eileen.roach@uhn.ca. 4. Division of General Surgery, University Health Network, Toronto, ON, Canada. 5. Department of Surgery, University of Toronto, Toronto, ON, Canada.
Abstract
BACKGROUND: Despite excellent reported outcomes after laparoscopic sleeve gastrectomy (LSG), a percentage of patients go on to have a secondary bariatric surgery to manage side-effects or address weight regain after LSG. Reported weight loss outcomes for patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) after previous LSG are variable. We sought to determine the weight-loss outcomes of patients undergoing LRYGB after LSG in the largest bariatric surgical network in Canada and to determine whether outcomes differ according to indications for conversion. METHODS: The Bariatric Registry is a multi-center database with prospectively collected standardized data on patients undergoing bariatric surgery at ten Bariatric Centers of Excellence within the Ontario Bariatric Network in Ontario, Canada. A retrospective analysis was performed of patients who underwent LRYGB after previous LSG between 2012 and 2019. Weight loss outcomes were compared between patients who underwent LRYGB for insufficient weight loss/weight regain and those who underwent conversion to LRYGB for other reasons. RESULTS: Excluding patients with multiple revisions and those without follow-up data, 48 patients were included in the analysis: 33 patients (69%) underwent conversion to LRGYB for insufficient weight loss/weight regain (Group 1) and 15 patients (31%) underwent conversion for other reasons (Group 2). Mean body mass index (BMI) measured pre-LSG, pre-LRYGB, and at mid-term follow-up after LRYGB was 61, 48, and 43 kg/m2 in Group 1 and 51, 39, and 34 kg/m2 in Group 2, respectively. ΔBMI and %total weight loss (TWL) at mid-term follow-up were not significantly different between the groups. CONCLUSIONS: Conversion to LRYGB after previous LSG resulted in an additional loss of 4 kg/m2 in BMI points at mid-term follow-up. Patients lost a similar number of BMI points and cumulative %TWL was similar regardless of reason for conversion. This can help inform surgical decision-making in the setting of weight regain after LSG.
BACKGROUND: Despite excellent reported outcomes after laparoscopic sleeve gastrectomy (LSG), a percentage of patients go on to have a secondary bariatric surgery to manage side-effects or address weight regain after LSG. Reported weight loss outcomes for patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) after previous LSG are variable. We sought to determine the weight-loss outcomes of patients undergoing LRYGB after LSG in the largest bariatric surgical network in Canada and to determine whether outcomes differ according to indications for conversion. METHODS: The Bariatric Registry is a multi-center database with prospectively collected standardized data on patients undergoing bariatric surgery at ten Bariatric Centers of Excellence within the Ontario Bariatric Network in Ontario, Canada. A retrospective analysis was performed of patients who underwent LRYGB after previous LSG between 2012 and 2019. Weight loss outcomes were compared between patients who underwent LRYGB for insufficient weight loss/weight regain and those who underwent conversion to LRYGB for other reasons. RESULTS: Excluding patients with multiple revisions and those without follow-up data, 48 patients were included in the analysis: 33 patients (69%) underwent conversion to LRGYB for insufficient weight loss/weight regain (Group 1) and 15 patients (31%) underwent conversion for other reasons (Group 2). Mean body mass index (BMI) measured pre-LSG, pre-LRYGB, and at mid-term follow-up after LRYGB was 61, 48, and 43 kg/m2 in Group 1 and 51, 39, and 34 kg/m2 in Group 2, respectively. ΔBMI and %total weight loss (TWL) at mid-term follow-up were not significantly different between the groups. CONCLUSIONS: Conversion to LRYGB after previous LSG resulted in an additional loss of 4 kg/m2 in BMI points at mid-term follow-up. Patients lost a similar number of BMI points and cumulative %TWL was similar regardless of reason for conversion. This can help inform surgical decision-making in the setting of weight regain after LSG.
Authors: Sean Wharton; David C W Lau; Michael Vallis; Arya M Sharma; Laurent Biertho; Denise Campbell-Scherer; Kristi Adamo; Angela Alberga; Rhonda Bell; Normand Boulé; Elaine Boyling; Jennifer Brown; Betty Calam; Carol Clarke; Lindsay Crowshoe; Dennis Divalentino; Mary Forhan; Yoni Freedhoff; Michel Gagner; Stephen Glazer; Cindy Grand; Michael Green; Margaret Hahn; Raed Hawa; Rita Henderson; Dennis Hong; Pam Hung; Ian Janssen; Kristen Jacklin; Carlene Johnson-Stoklossa; Amy Kemp; Sara Kirk; Jennifer Kuk; Marie-France Langlois; Scott Lear; Ashley McInnes; David Macklin; Leen Naji; Priya Manjoo; Marie-Philippe Morin; Kara Nerenberg; Ian Patton; Sue Pedersen; Leticia Pereira; Helena Piccinini-Vallis; Megha Poddar; Paul Poirier; Denis Prud'homme; Ximena Ramos Salas; Christian Rueda-Clausen; Shelly Russell-Mayhew; Judy Shiau; Diana Sherifali; John Sievenpiper; Sanjeev Sockalingam; Valerie Taylor; Ellen Toth; Laurie Twells; Richard Tytus; Shahebina Walji; Leah Walker; Sonja Wicklum Journal: CMAJ Date: 2020-12-07 Impact factor: 8.262
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