Jerry T Dang, BSc, MD1, Samuel L Skulsky, BSc2, Noah J Switzer, BSc, MD1, Caolan Walsh, BSc, MD3, Xinzhe Shi, MPH4, Shahzeer Karmali, BSc, MPH, MD4, Amy Neville, BSc, MSc, MD3. 1Department of Surgery, University of Alberta, 2Faculty of Medicine and Dentistry, University of Alberta, 3Department of Surgery, University of Ottawa, 4Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital
INTRODUCTION: Our aim was to systematically review the literature to compare weight loss outcomes and safety of secondary surgery after sleeve gastrectomy (SG), particularly between Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (BPD-DS). SG was originally developed as the first part of a two-stage procedure for BPD-DS. However, it is now the most common standalone bariatric surgery performed in the United States.
The majority of SG are done as the sole bariatric operation but in 3%, a second operation is necessary, due to insufficient weight loss, weight regain or reflux. The most common second-stage operations are RYGB at 46% and BPD-DS at 24%. There are a few small case series comparing RYGB to BPD-DS as a secondary surgery after SG. These studies suggest that after failed SG, BPD-DS results in greater weight loss but higher early complication rates than RYGB.
METHODS: A comprehensive search of MEDLINE, EMBASE, SCOPUS, the Cochrane Library, and Web of Science from 1946 to March 2017 was completed. Title searching was restricted to the following keywords/terms: gastric bypass OR biliopancreatic diversion OR duodenal switch AND sleeve gastrectomy and revision*/conversion*/secondary/fail*. Included studies contained ≥ 5 adult patients who underwent sleeve gastrectomy followed by RYGB and BPD-DS. Studies had to directly compare RYGB with BPD-DS.
RESULTS: Six primary studies (109 patients) were included, four of which underwent meta-analysis. There were 61 second-stage surgeries to RYGB and 48 to BPD-DS. The indications for RYGB were failed weight loss (65.1%), reflux (20.9%), dysphagia (9.3%), or as a planned two-step procedure (4.7%). BPD-DS indications were either failed weight loss (76.6%) or as a planned two-step procedure (23.4%). In three of the studies, mean change in BMI was not significant between BPD-DS and RYGB (11.0 kg/m2 versus 8.54 kg/m2, MD -1.70, CI -6.73 to 3.34, p=0.51).
Second-stage BPD-DS had statistically significantly higher rates of malnutrition, vitamin and mineral deficiency compared to second-stage RYGB (54.1% vs. 21.6%, RD -0.19, CI -0.36 to -0.01, p=0.04). However, bleeding, leak, marginal ulceration and reoperation rates were not significantly different.
CONCLUSION: Second-stage BPD-DS and RYGB following SG result in similar BMI change but BPD-DS had significantly higher rates of malnutrition, vitamin or mineral deficiencies. However, sample sizes in this systematic review were small and further studies are needed to clarify differences in weight change and complication rates following second-stage BPD-DS and RYGB.
Malnutrition, mineral and vitamin deficiencies in second-stage RYGB vs BPD-DS after SG
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86848
Program Number: P619
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster