Conversion of sleeve Gastrectomy to Roux-en-Y Gastric bypass for weight loss failure

Background: Obesity is a global health issue. Laparoscopic sleeve gastrectomy has progressively become the most popular procedure among the surgical community as a definitive bariatric operation. The increasing number of surgeries performed will be likely be followed by increasing reports of patients experiencing weight loss failure.Objectives: To determine the effectiveness of conversion from laparoscopic sleeve gastrectomy to Roux-en-Y gastric bypass in cases with weight loss failure.Patient &methods: The retrospective review of patients who had operated with laparoscopic sleeve gastrectomy from October 2009 to January 2016 at Saint Raphael hospital, 21 patients included in this study had insufficient weight loss after Sleeve Gastrectomy and converted to Roux-en-Y gastric bypass.Results: Fifteen patients (71.4%) had LSG as their single bariatric operation before conversion to roux en Y gastric bypass, 2 patients (9.5%) had Intragastric balloon and 4 (19.1%) patients had the laparoscopic adjustable gastric band before to their sleeve gastrectomy. Fourteen patients (66.6%) were female and 7 (33.4%) were males, At 6, 12, 18 months after bypass ,mean BMI was 37.2 (32.7-44.3),32.5(28.7-39.1) and 30.2 kg/m2 (24.3-37.9 kg/m2) respectively , reflecting a %EWL (percentage weight loss) at 18 month of 61.7%.Conclusion: insufficient weight loss after Sleeve Gastrectomy can be safely and effectively treated by conversion to Roux-en-Y gastric bypass to control weight loss failure or weight regain.Keywords: weight loss failure, weight regain, failed Sleeve Gastrectomy تحويل عملية قص المعدة الى عملية تحويل مسار المعدة للمرضى الذين فشلوا في فقدان الوزن د. محمد قاسم عبدالجبار د. رامز سامي مختار د. مصطفى عادل عباس الخلاصة: خلفية: البدانة لا تزال تمثل مصدر قلق كبير في جميع أنحاء العالم. وقد اكتسبت استئصال و تكميم المعدة بالمنظار شعبية كبيرة بين المجتمع الجراحي باعتباره إجراء جراحي مستقل. ومن المرجح أن يتبع العدد المتزايد في اجراء قَص وتكميم المعدة بوجود إعداد متزايدة من المرضى الذين يعانون من فشل في فقدان الوزن ، وتعرف بأن فقدان الوزن غير كافي أو اكتساب الوزن من جديد. الهدف من الدراسة: لتقييم فعالية تحويل قَص وتكميم المعدة الى عملية تحويل مسار المعدة في موضوع فشل فقدان الوزن المرضى والطرق: استعراض بأثر رجعي للمرضى الذين خضعوا لقص وتكميم المعدة بالمنظار من تشرين الاول ٢٠٠٩ حتى كانون الاول ٢٠١٦في مستشفى القديس رافائيل(الراهبات)، خضع ٢١ مريضا يعانون من فشل في فقدان الوزن بعد عملية قَص وتكميم المعدة الى عملية تحويل مسار المعدة بالناظور وتمت متابعة فقدان الوزن لدى المرضى لمدة ١٨ شهر أو اكثر. النتائج: خضع سبعة عشر مريضا (٨٠.٩٪) لعملية قَص وتكميم المعدة كإجراء وحيد ، وخضع ٤ (١٩.١٪) من المرضى لعملية قرص المعدة قبل اجراء قَص وتكميم المعدة. وكان ١٤ مريضا (٦٦.٦٪) من الإناث و ٧ (٣٣.٤٪) من الذكور، في الشهر السادس و والاثنا عشر والثامن عشر شهرا بعد بعد تحويل مسار المعدة، كان متوسط مؤشر كتلة الجسم ٣٧.٢ (٣٢.٧-٤٤.٣)، ٣٢.٥ (٢٨.٧-٣٩.١) و ٣٠.٢ كجم / م ٢ (٢٤.٣ -٣٧.٩ كغ / م ٢) على التوالي، مما يعكس (نسبة فقدان الوزن) في الشهر الثامن عشر ٦١.٧٪. الاستنتاج: عملية تحويل مسار المعدة بالناظور بعد فشل فقدان الوزن بعد عملية قَص وتكميم المعدة هو اجراء أمن وفعال. كلمات البحث: فشل في فقدان الوزن ،استعادة الوزن، فشل قَص وتكميم المعدة

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Laparoscopic Adjustable Gastric Band: Complications, Removal and Revision in a Portuguese Highly Differentiated Obesity Treatment Center

Acta Médica Portuguesa ◽

10.20344/amp.6369 ◽

2015 ◽

Vol 28 (6) ◽

pp. 735 ◽

Cited By ~ 2

Author(s):

Alfredo Mendes-Castro ◽

Joana Montenegro ◽

Jorge Félix Cardoso ◽

Gisela Simões ◽

Catarina Ferreira ◽

...

Keyword(s):

Weight Loss ◽

Gastric Bypass ◽

Sleeve Gastrectomy ◽

Gastric Banding ◽

Laparoscopic Sleeve Gastrectomy ◽

Laparoscopic Adjustable Gastric Banding ◽

Revision Surgery ◽

Adjustable Gastric Banding ◽

Laparoscopic Adjustable Gastric Band ◽

Treatment Center

Introduction: Our objective is to determine which complications lead to reoperation, and the outcomes of reoperation using laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy at Centro Hospitalar de São João. Material and Methods: Observational study. Patients included were aged 18 to 65 years at first gastric banding, underwent removal from March 21st 2007 to January 23rd 2014 and were subsequently converted to gastric banding, gastric bypass or sleeve gastrectomy. Women who got pregnant during the initial gastric banding follow-up and patients that performed more than one conversion were excluded. Results: A total of 103 patients were included. Fifteen underwent revision to gastric banding, 71 to gastric bypass and 17 to sleeve gastrectomy. Respectively, percentage of excess weight loss at 1 month were 1.9 ± 12.2% in 6 patients, 36.9 ± 18.2% in 49 patients and 27.1% (13.3 - 68.6) in 11 patients (laparoscopic adjustable-gastric banding-laparoscopic Roux-en-Y gastric bypass p < 0.001, laparoscopic adjustable-gastric banding-laparoscopic sleeve gastrectomy p = 0.002 and laparoscopic Roux-en-Y gastric bypass-laparoscopic sleeve gastrectomy p = 0.474). At 3 months there were 12.8% (5.7 - 84.8) in 6 patients, 44.8 ± 19.7% in 24 patients and 48 ± 20.1% in 8 patients (laparoscopic adjustable-gastric banding-laparoscopic Roux-en-Y gastric bypass p = 0.017, laparoscopic adjustable-gastric banding-laparoscopic sleeve gastrectomy p = 0.039 and laparoscopic Roux-en-Y gastric bypass-laparoscopic sleeve gastrectomy p = 0.691). Discussion: At revision, ages and body mass indices are higher than other studies. Gastric bypass is the preferred revision surgery, because combines restriction and malabsorption, surgeons have more experience and long term outcomes are better described. Conclusions: The main indications for reoperation were inadequate weight loss (37.4%) and band slippage (30%). At short term, in our patients, gastric banding as a revision surgery was not effective, as opposed to gastric bypass and sleeve gastrectomy.

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