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. 2022 Feb;36(2):1080-1089.
doi: 10.1007/s00464-021-08374-5. Epub 2021 Feb 24.

Conversion of laparoscopic sleeve gastrectomy after weight loss failure into laparoscopic one anastomosis gastric bypass: short-term safety and efficacy and effect of indications on outcome

Wadie Boshra Gerges  1 , Hisham Omran  2 , Fady Makram  2
Affiliations

Conversion of laparoscopic sleeve gastrectomy after weight loss failure into laparoscopic one anastomosis gastric bypass: short-term safety and efficacy and effect of indications on outcome

Wadie Boshra Gerges et al. Surg Endosc. 2022 Feb.

Abstract

Background: Revisional surgery after failed laparoscopic sleeve gastrectomy (LSG) is growing and laparoscopic one anastomosis gastric bypass (LOAGB) has been proposed as a revisional procedure due to its combined restrictive and malabsorptive effects. The aim is to study short-term complications and weight loss (WL) results of the revisional LOAGB after LSG for the two-weight loss failure (WLF) types [insufficient weight loss (IWL) and weight regain (WR)] and to assess the possible effects of these two types of failure and gastric tube anatomy on the final outcome.

Methods: The data of 28 patients who completed 1-year follow-up for their revisional LOAGB after their failed LSG were assessed and statistically correlated to leakage and one year WL results.

Results: Operative time was 96 ± 17.4 min. Leakage occurred in 2 patients (7.1%); the small number of leak patients does not allow statistical analysis for leakage. Percentage of excess weight loss (%EWL) at one year was 79.0 ± 14.4%; percentage of total weight loss (%TWL) was 31.7 ± 6.4%. %EWL was 84.2 ± 13.1 with IWL and 73.0 ± 13.9 with WR (P = 0.036). %TWL was 35.0 ± 5.2 with IWL and 27.8 ± 5.5 with WR (P = 0.001). %TWL at persistent fundus, diffusely dilated, and nondilated stomach were 38.98 ± 4.57, 31.3 ± 5.33, and 28.54 ± 5.91, respectively (P = 0.006).

Conclusion: LOAGB is a highly effective and safe procedure as a revision after LSG with WLF. Patients with IWL and patients with persistent fundus lost more weight than those with WR and those with diffuse stomach dilation or nondilation, respectively.

Keywords: Indications; LSG; Laparoscopic one anastomosis gastric bypass; Outcomes; Revisional bariatric surgery; Weight loss failure.

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