Long-Term Effectiveness of Laparoscopic Conversion of Sleeve Gastrectomy to a Biliopancreatic Diversion with a Duodenal Switch or a Roux-en-Y Gastric Bypass due to Weight Loss Failure

Abstract

Background: Gastroesophageal reflux disease and inadequate weight loss (IWL) are long-term complications of laparoscopic sleeve gastrectomy (LSG) and indications for a laparoscopic conversion to an alternative bariatric procedure. The aim of this study is to report the long-term outcomes of biliopancreatic diversion with a duodenal switch (DS) or a Roux-en-Y gastric bypass (RYGB) as conversion procedures for weight loss failure after LSG.

Methods: The data of all patients who underwent post-LSG conversion to either a RYGB or a DS at our institution between November 2006 and May 2016 was retrospectively analyzed. Included were all patients with > 1-year follow-up who were operated due to IWL or weight regain. Patients with the indication of reflux were excluded.

Results: Sixty-six patients underwent conversion from LSG to RYGB, DS, or one-anastomosis gastric bypass during the study period. There were 21 revisions to DS and 18 to RYGB that met the inclusion criteria. The respective weight and body mass index (BMI) before and after LSG were 125 and 110 kg and 46 and 40.5 kg/m² in the RYGB group and 148 and 126 kg and 53.7 and 46 kg/m² in the DS group. At the last follow-up (> 2 years), 15 RYGB patients had a reduction in BMI of 8.5-31.9 kg/m² and 18 DS patients had a reduction in BMI of 12.8-31.9 kg/m². The mean follow-up was 48.5 months (range 24-76). All comorbidities improved or underwent complete remission.

Conclusion: Conversion from SG to RYGB or DS is an efficient and effective treatment for IWL and improvement of comorbidities. Further studies are warranted to evaluate long-term weight regain.

Keywords: Conversional bariatric surgery; Laparoscopic Roux-en-Y gastric bypass; Laparoscopic biliopancreatic diversion with duodenal switch; Laparoscopic sleeve gastrectomy failure.