The Feasibility of Laparoscopic Roux-en-Y-Gastric Bypass Versus Laparoscopic Re-sleeve Gastrectomy As Conversional Procedures After Failed Laparoscopic Sleeve Gastrectomy.

Nourah Alsharqawi, Salman Alsabah, Ahmed Almulla, Shehab Ekrouf, Saud Al Subaie, Talib Jumaa. Al Amiri Hospital

Background: Laparoscopic Sleeve Gastrectomy (LSG) is gaining popularity worldwide due to its success on a short term basis. However, long term follow up results included insufficient weight loss and weight regain that required surgical intervention. Laparoscopic Roux-en-Y-Gastric Bypass (LRYGB) and Laparoscopic Re-sleeve Gastrectomy (LRSG) are currently being studied as conversional techniques for failed LSG. This study aims at assessing the success rate of these conversional techniques.

Methods: A retrospective analysis of 1300 patients underwent LSG from February 2009 to October 2012 in AlAmiri Hospital, Kuwait, of which 11 patients underwent LRYGB and 9 patients underwent LRSG. Data included length of stay, percentage of excessive weight loss (EWL%), and Body Mass Index (BMI).

Results: A total of 11 patients underwent conversion from LSG to LRYGB due to insufficient weight loss (73%) and weight regain (27%) after a mean interval of 4 years and 9 patients underwent conversion from LSG to LRSG due to insufficient weight loss after a mean interval of 2.5 years. Mean age was 35 years, 85% were females. The mean weight and BMI prior to LSG for the LRYGB and LRSG patients were 128kg and 49kg and 142kg and 50, respectively. The EWL% after the initial LSG was 46% and 35.1%, for the LRYGB and LRSG, respectively. There were no complications recorded. Mean length of stay in hospital was 3 days and 2 days after LRYGB and LRSG, respectively. Results of conversion of LSG to LRYGB involved a mean end weight and EWL% of 90kg and 63% respectively over an interval of 9 months. Results of LSRG involved a mean end weight, and EWL% of 84, and 48.9% respectively over a period of one year. A significant increase in EWL% from LSG to LRYGB was recorded with a p-value of 0.009. In addition, a significant increase in EWL% from LSG to LRSG was documented with a p-value of 0.05. A comparison of the EWL% of LRYGB and LRSG for failed primary LSG was not significant with a p-value of 0.097.

Conclusion: Both LRYGB and LRSG groups demonstrated a significant reduction in weight. However, the LRYGB group illustrated more weight loss. These results have been recorded on a short term basis. Larger and longer follow up studies are required to validate the results.