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

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Abstract

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/m2. 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.

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Acknowledgements

No individuals other than the stated authors contributed to this study.

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Authors and Affiliations

  1. Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA

    Joshua P. Landreneau, Andrew T. Strong, John H. Rodriguez, Essa M. Aleassa, Ali Aminian, Stacy Brethauer, Philip R. Schauer & Matthew D. Kroh

  2. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA

    Andrew T. Strong, John H. Rodriguez, Ali Aminian, Stacy Brethauer, Philip R. Schauer & Matthew D. Kroh

  3. Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

    Matthew D. Kroh

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  1. Joshua P. Landreneau
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Correspondence to Joshua P. Landreneau.

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Conflict of Interest

John H. Rodriguez has no conflict of interest relevant to this publication and has received research funding from Pacira Pharmaceuticals and Intuitive Surgical. Stacy Brethauer has no conflict of interest relevant to this publication, is a consultant for Ethicon, and has been a speaker for Ethicon and Covidien. Philip R. Schauer has no conflict of interest relevant to this publication; has been a speaker for Ethicon; has received research funding from Ethicon, Medtronic, and Pacira Pharmaceuticals; and is on the advisory boards of AMAG Pharmaceuticals, GI Dynamics, Pacira Pharmaceuticals, and Neurotronic. Matthew D. Kroh has no conflict of interest relevant to this publication, is a consultant for Levita Magnetics, and has received research funding from Cook Biotech, Medtronic, and Pacira Pharmaceuticals. Joshua P. Landreneau, Andrew T. Strong, Essa M. Aleassa, and Ali Aminian have no conflict of interest or financial ties to disclose.

Statement Regarding Ethics and Informed Consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent was not required.

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Landreneau, J.P., Strong, A.T., Rodriguez, J.H. et al. Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass. OBES SURG 28, 3843–3850 (2018). https://doi.org/10.1007/s11695-018-3435-1

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