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Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass is Effective for Gastro-Oesophageal Reflux Disease but not for Further Weight Loss

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Abstract

Introduction

Inadequate weight loss (IWL)/weight regain (WR) and gastro-esophageal reflux disease (GERD), unresponsive to medical management, are two most common indications for conversion of sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB). This study reports detailed outcomes of conversion of SG to RYGB for these two indications separately.

Methods

We interrogated our prospectively maintained database to identify patients who underwent a conversion of their SG to RYGB in our unit. Outcomes in patients converted for IWL/WR and those converted for GERD were evaluated separately.

Results

We carried out 22 SG to RYGB in our unit between Aug 2012 and April 2015 with a mean follow-up of 16 months. Indication for conversion was GERD in 10/22 (45.5%) patients and IWL/WR in 11/22 (50.0%) patients. Patients undergoing conversion for GERD were significantly lighter (BMI 30.5) than those converted for IWL/WR (BMI 43.3) at the time of conversion. The conversion was very effective for GERD with 100% patients reporting improvement in symptoms, and 80% patients were able to stop their antacid medications. IWL/WR group achieved a further BMI drop of 2.5 points 2 years after surgery (final BMI 40.8) in comparison with 2.0 points BMI drop achieved by the GERD group (final BMI 28.5).

Conclusion

This study demonstrates that conversion of SG to RYGB is effective for GERD symptoms but not for further weight loss, which was modest in both groups. Future studies need to examine the best revisional procedure for IWL/WR after SG.

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References

  1. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32.

    Article  CAS  PubMed  Google Scholar 

  2. Gautier T, Sarcher T, Contival N, et al. Indications and mid-term results of conversion from sleeve gastrectomy to Roux-en-Y gastric bypass. Obes Surg. 2013;23(2):212–5.

    Article  PubMed  Google Scholar 

  3. Homan J, Betzel B, Aarts EO, et al. Secondary surgery after sleeve gastrectomy: Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis. 2015;11(4):771–7.

    Article  PubMed  Google Scholar 

  4. AlSabah S, Alsharqawi N, Almulla A, Akrof S, Alenezi K, Buhaimed W, Al-Subaie S, Al Haddad M. Approach to poor weight loss after laparoscopic sleeve gastrectomy: re-sleeve vs. gastric bypass. Obes Surg 2016;26(10):2302–7.

  5. Langer FB, Bohdjalian A, Shakeri-Leidenmühler S, et al. Conversion from sleeve gastrectomy to Roux-en-Y gastric bypass—indications and outcome. Obes Surg. 2010;20(7):835–40.

    Article  PubMed  Google Scholar 

  6. Abdemur A, Fendrich I, Rosenthal R. Laparoscopic conversion of laparoscopic sleeve gastrectomy to gastric bypass for intractable gastresophageal reflux disease. Surg Obes Relat Dis. 2012;8(5):654.

    Article  PubMed  Google Scholar 

  7. Parikh A, Alley JB, Peterson RM, et al. Management options for symptomatic stenosis after laparoscopic vertical sleeve gastrectomy in the morbidly obese. Surg Endosc. 2012;26(3):738–46.

    Article  PubMed  Google Scholar 

  8. Moon RC, Shah N, Teixeira AF, Jawad MA. Management of staple line leaks following sleeve gastrectomy. Surg Obes Relat Dis 2015;11(1):54–9.

  9. Abdemur A, Han SM, Lo Menzo E, et al. Reasons and outcomes of conversion of laparoscopic sleeve gastrectomy to Roux-en-Y gastric bypass for nonresponders. Surg Obes Relat Dis. 2016;12(1):113–8.

    Article  PubMed  Google Scholar 

  10. Bellorin O, Lieb J, Szomstein S, et al. Laparoscopic conversion of sleeve gastrectomy to Roux-en-Y gastric bypass for acute gastric outlet obstruction after laparoscopic sleeve gastrectomy for morbid obesity. Surg Obes Relat Dis. 2010;6(5):566–8.

    Article  PubMed  Google Scholar 

  11. Cheung D, Switzer NJ, Gill RS, et al. Revisional bariatric surgery following failed primary laparoscopic sleeve gastrectomy: a systematic review. Obes Surg. 2014;24(10):1757–63.

    Article  PubMed  Google Scholar 

  12. Welbourn R, Small P, Finlay I, Sarela A, Somers S, Mahawar K. Second National Bariatric Surgery Report. http://www.bomss.org.uk/wp-content/uploads/2014/04/Extract_from_the_NBSR_2014_Report.pdf.

  13. van Rutte PW, Smulders JF, de Zoete JP, et al. Indications and short-term outcomes of revisional surgery after failed or complicated sleeve gastrectomy. Obes Surg. 2012;22(12):1903–8.

    Article  PubMed  Google Scholar 

  14. Bindal V, Gonzalez-Heredia R, Elli EF. Outcomes of robot-assisted Roux-en-Y gastric bypass as a reoperative bariatric procedure. Obes Surg. 2015;25(10):1810–5.

    Article  PubMed  Google Scholar 

  15. Silecchia G, De Angelis F, Rizzello M, et al. Residual fundus or neofundus after laparoscopic sleeve gastrectomy: is fundectomy safe and effective as revision surgery? Surg Endosc. 2015;29(10):2899–903.

    Article  PubMed  Google Scholar 

  16. Carmeli I, Golomb I, Sadot E, et al. Laparoscopic conversion of sleeve gastrectomy to a biliopancreatic diversion with duodenal switch or a Roux-en-Y gastric bypass due to weight loss failure: our algorithm. Surg Obes Relat Dis. 2015;11(1):79–85.

    Article  PubMed  Google Scholar 

  17. Moszkowicz D, Rau C, Guenzi M, et al. Laparoscopic omega-loop gastric bypass for the conversion of failed sleeve gastrectomy: early experience. J Visc Surg. 2013;150(6):373–8.

    Article  CAS  PubMed  Google Scholar 

  18. Mahawar KK, Jennings N, Balupuri S, et al. Sleeve gastrectomy and gastro-esophageal reflux disease: a complex relationship. Obes Surg. 2013;23(7):987–91.

    Article  PubMed  Google Scholar 

  19. Hendricks L, Alvarenga E, Dhanabalsamy N, et al. Impact of sleeve gastrectomy on gastresophageal reflux disease in a morbidly obese population undergoing bariatric surgery. Surg Obes Relat Dis. 2016;12(3):511–7.

    Article  PubMed  Google Scholar 

  20. Mahawar KK, Jennings N, Brown J, et al. “Mini” gastric bypass: systematic review of a controversial procedure. Obes Surg. 2013;23(11):1890–8.

    Article  PubMed  Google Scholar 

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Author Contribution

KM conceived the idea for the topic and wrote the manuscript. CP collected most of the data and helped with manuscript writing. KM and CP contributed equally to the manuscript. MB provided some of the data. PKS, SB, NS, and KM performed the operations. All authors participated in the departmental discussions on the topic. All authors have seen the final version and approve of it.

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Authors and Affiliations

  1. Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK

    Chetan D Parmar, Kamal K Mahawar, Maureen Boyle, Norbert Schroeder, Shlok Balupuri & Peter K Small

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  1. Chetan D Parmar
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  2. Kamal K Mahawar
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  3. Maureen Boyle
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  4. Norbert Schroeder
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  5. Shlok Balupuri
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  6. Peter K Small
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Corresponding author

Correspondence to Kamal K Mahawar.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Statement of Human and Animal Rights

This is not applicable for a retrospective audit of a routine procedure in our unit.

Statement of Informed Consent

For this type of retrospective study, formal consent is not required.

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None.

Additional information

Chetan D Parmar and Kamal K Mahawar contributed equally.

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Parmar, C.D., Mahawar, K.K., Boyle, M. et al. Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass is Effective for Gastro-Oesophageal Reflux Disease but not for Further Weight Loss. OBES SURG 27, 1651–1658 (2017). https://doi.org/10.1007/s11695-017-2542-8

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  • DOI: https://doi.org/10.1007/s11695-017-2542-8

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