Revision of failed restrictive procedures to laparoscopic Roux en Y gastric bypass (LRYGB) in single stage compared to primary LRYGB

Maha K Ibrahim, MD1, Mohammed B Al Hadad, MD1, Ahmed Maasher, MD1, Anas Mihchieh, MD2, Maria Margarita, RN1, Abdelrahman A Nimeri, MD, FACS, FASMBS1. 1Sheikh Khalifa Medical City, 2Cairo University College of Medicine

Background: Weight recidivism is not uncommon after restrictive bariatric surgeries including laparoscopic adjustable gastric band (LAGB), vertical banded gastroplasty (VBG) and laparoscopic sleeve gastrectomy (LSG). Theoretically if a patient fails a restrictive bariatric procedure, then conversion to another restrictive procedure should be avoided. We present herein our experience in converting failed restrictive bariatric procedures to LRYGB compared to our primary LRYGB series.

Methods: We reviewed our prospectively maintained database for all LRYGB following a failed restrictive procedure and our primary LRYGB performed from September 2009-2014. IRB approval was obtained. Our strategy is to convert failed restrictive bariatric procedures to LRYGB in one stage.

Results: A total of 720 bariatric procedures were performed including 65 revisional LRYGB and 354 primary LRYGB cases. Revisional LRYGB included 49 cases of conversion of a failed LAGB, 10 and 6 cases of conversion of failed LSG and VBG respectively. Mean BMI for revisional and primary LRYGB was 46.5 and 48 kg/m respectively. Mortality rate in the entire series was 0%. Leak rate in revisional and primary LRYGB was 1.5% and 0.6% respectively. Rate of DVT,PE and portal vein thrombosis was 0% in revisional LRYGB and 0.6%, 0.3% and 0.6% in primary LRYGB. Bleeding requiring blood transfusion or reoperation in revisional LRYGB was 0% and in primary LRYGB was 0.6% and 0.6%. Stenosis rate in revisional and primary LRYGB was 1.5% and 0.3% respectively. Pneumonia and UTI rates in revisional LRYGB were 0% and in primary LRYGB was 0.3% and 0.3% respectively. Readmission in revisional and primary LRYGB was 7.7% and 2.8% respectively. The excess weight loss at one year for our revisional and primary LRYGB was 60% and 76% respectively.

Conclusion Our data suggest that revision of failed restrictive procedures to LRYGB is safe and effective but has a lower Excess weight loss at one year compared to primary LRYGB.

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