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Comparison of standard and long alimentary limbs in conversion of sleeve gastrectomy to Roux-en-Y gastric bypass for weight loss

Jingliang Yan, MD, PhD1, Andrew Strong, MD1, Joshua Landreneau, MD1, John Rodriguez, MD1, Matthew Kroh, MD2. 1Cleveland Clinic, Cleveland OH, USA, 2Cleveland Clinic, Cleveland OH, USA and Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE

Introduction: Conversion of sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB) may be performed either as a planned second stage operation, or as a revisional procedure for weight recidivism. In this setting, the role of a longer alimentary limb in promoting weight loss and reducing comorbidities has not been well established.

Methods and procedures: After IRB approval, patients undergoing conversion of SG to RYGB for weight related issues from 2007 to 2016 were identified. Conversions due to SG complications was excluded. Standard RYGB had a 150-cm alimentary limb, while long limb bypass (LL RYGB) had a 200, 250, 300 or 350-cm alimentary limb. Decision on the alimentary limb length was made by individual surgeon. Demographics, weight loss profile, comorbidities and nutritional status were retrieved and analyzed.

Results: Thirty-nine patients meeting the criteria were identified. Seventeen patients underwent standard RYGB, and 22 underwent LL-RYGB. Average time between SG and RYGB was 21 months in the standard group, and 29 months in the long limb group. In the standard RYGB group, average weight and BMI at the time of SG and RYGB were 172 kg, 61 kg/m2, and 142 kg, 50 kg/m2, respectively. In the LL-RYGB group, average weight and BMI at the time of SG and RYGB were 188 kg, 65 kg/m2, and 151 kg, 53 kg/m2, respectively. There was no statistical difference between the 2 groups. Absolute weight loss and EWL% for the standard RYGB group were 19 kg and 32% at 6 months and 26 kg and 37% at 1 year follow up. For the LL-RYGB group, they were 17 kg and 22% at 6 months, and 17 kg and 23% at 1 year. Of the 9 standard and 10 LL RYGB patients who still had either diabetes or hypertension at the time of RYGB, 5/9 (56%) and 3/10 (30%) had improvement or resolution of diabetes or hypertension at follow up. Among those with laboratory values available, 64% of standard RYGB and 60% of LL-RYGB patients had postoperative iron deficiency, vitamin D deficiency or both. One patient who had a 250-cm alimentary limb suffered from Wernicke’s encephalopathy due to severe thiamine deficiency.

Conclusion: When converting from SG to RYGB, an alimentary limb >150 cm may not offer additional benefits in weight loss or resolution of weight related comorbidities. Longer alimentary limbs may also be associated with severe nutritional deficiencies.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 87507

Program Number: P628

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

Post Views: 44

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