Essa M Aleassa, MD, Kellen Hayes, MD, Moinque Hassan, MD, Voranaddha Vacharathit, MD, Philip R Schauer, MD, Stacy Brethauer, MD, Ali Aminian, MD. Bariatric and Metabolic Center, DDI, Cleveland Clinic OH
Introduction: Revisional bariatric surgery can sometimes be the only resort to improve outcomes and to resolve complications of sleeve gastrectomy (SG). Roux-en-Y gastric bypass (RYGB) is one of the most common revisional procedures done after SG. The aim of this study was to identify the indications for and the effect of revisional RYGB on the body weight, diabetes status and gastroesophageal reflux disease (GERD) post-SG.
Methods: Clinical data of 87 patients who underwent conversion of their initial SG to a RYGB at an academic center between 2008 and 2014 were reviewed.
Results: Mean age and body mass index (BMI) at the time of conversion of SG to RYGB were 47.6±11.6 years and 43.4±13.9 kg/m2, respectively. Weight recidivism was the most common indication for revisional surgery (n=53, 60.9%), followed by intractable GERD (n=14, 16.1%), and gastric fistula (n=8, 9.2%). Only 2 (2.3%) patients underwent urgent conversion for management of complications after SG. Three patients had intraoperative complications necessitating blood transfusion. Fourteen (16.1%) patients required readmission within 30 days postoperatively. Six patients (6.9%) required surgical interventions including 2 for gastrointestinal leak, 2 for hemodynamic instability, 1 for a cecal perforation, and 1 for a small bowel obstruction. There were no mortalities within the first year of revisional surgery. In 62 patients with BMI>35 kg/m2 at the time of revisional surgery, at the median postoperative follow-up of 30 (interquartile range, 14-72) months, a median 6 (interquartile range, 2-9) kg/m2 reduction in BMI was observed. Overall, 19 (21.8%) patients had persistent type 2 diabetes at time of revisional surgery. Improvement of diabetes was observed in 15 patients (78.9%) after conversion of SG to RYGB. Among 14 patients with GERD symptoms, subjective symptomatic relief was reported at the last follow-up.
Conclusion: Weight recidivism is the most common indication for revision of SG. Conversion of SG to RYGB leads to a median 6 kg/m2 reduction in BMI. In addition, RYGB would be effective in controlling residual diabetes and GERD after SG. However, conversion of SG to RYGB carries a higher surgical risk than primary RYGB. This emphasizes on the importance of patient selection and preoperative optimization.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88382
Program Number: P651
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster