Laparoscopic conversion of sleeve gastrectomy to a biliopancreatic diversion with duodenal switch or a Roux-en-Y gastric bypass due to weight loss failure: our algorithm

Published on Jan 1, 2015in Surgery for Obesity and Related Diseases4.734
· DOI :10.1016/J.SOARD.2014.04.012
Idan Carmeli4
Estimated H-index: 4
(Rabin Medical Center),
Inbal Golomb2
Estimated H-index: 2
(TAU: Tel Aviv University)
+ 2 AuthorsAndrei Keidar25
Estimated H-index: 25
(Rabin Medical Center)
Sources
Abstract
Abstract Background Failed sleeve gastrectomy (SG), defined by inadequate weight loss or weight regain, can be treated by a laparoscopic conversion to a biliopancreatic diversion with duodenal switch (DS) or a Roux-en-Y gastric bypass (RYGB). We report the outcomes of these procedures after SG failure. Methods All patients who underwent DS (n = 9) or RYGB (n = 10) due to inadequate weight loss or weight regain between December 2006 and November 2012 after a failed SG were enrolled. Results The mean pre-SG weight and body mass index (BMI) for the DS and RYGB patients were 143±36 kg and 51.5±11 kg/m 2 and 120±26 kg and 44.5±5 kg/m 2 , respectively. The interval between the SG and the conversion to DS and to RYGB was 27±18 months and 36±17 months, respectively. The operation time and hospital stay were 191±64 minutes and 4.3±2.4 days for DS, and 111±37 minutes and 3.1±1.1 days for RYGB. At reoperation, the weight, BMI and percentage of excess weight loss (%EWL) were 113±22 kg, 43±6 kg/m 2 and 28±16.5% and 107±27.5 kg, 40±5.7 kg/m 2 and 25±12.7% (all P >.05), for the DS and RYGB, respectively. None of the patients were lost to follow-up. The post-DS weight, BMI, and %EWL were 84±19 kg, 30.7±7.4 kg/m 2 , and 80±40%. The post-RYGB weight, BMI, and %EWL were 81±21 kg, 30.2±4.8 kg/m 2 , and 65.5±34% (all P > .05). Conclusion DS and RYGB are feasible and effective operations after a failed SG. The DS yields a greater weight loss. The mechanism of failure should guide selection of the second procedure.
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References23
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Introduction Laparoscopic sleeve gastrectomy (LSG) is becoming a very common bariatric procedure, based on several advantages it carries over more complex bariatric procedures such as gastric bypass or duodenal switch (DS), and a better quality of life over gastric banding. However, in the long-term follow-up, weight loss failure and intractable severe reflux after primary LSG can necessitate further surgical interventions, and revisional sleeve gastrectomy (ReSG) can represent an option to corr...
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#1Antonio Iannelli (University of Nice Sophia Antipolis)H-Index: 45
#2Anne-Sophie Schneck (University of Nice Sophia Antipolis)H-Index: 23
Last. Jean Gugenheim (University of Nice Sophia Antipolis)H-Index: 58
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Abstract Background The prevalence of superobesity (body mass index [BMI] ≥50 kg/m 2 ) has increased steadily during the past decade, and the most suitable surgical strategy for these patients is still controversial. Our objective was to test the hypothesis that in selected superobese patients, laparoscopic sleeve gastrectomy (SG) followed by laparoscopic duodenal switch (DS) might reduce the rate of postoperative complications and the need for the second step duodenal switch. The setting was a ...
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#1Thomas Gautier (UNICAEN: University of Caen Lower Normandy)H-Index: 1
#2Thomas Sarcher (UNICAEN: University of Caen Lower Normandy)H-Index: 1
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Sleeve gastrectomy (SG) is currently considered as a primary bariatric surgery. This is because of its relative simplicity and satisfactory results. As observed with other bariatric procedures, surgeons are confronted with insufficient weight loss or weight regain, insufficient resolution of metabolic disorders, and intractable severe reflux. A retrospective analysis of conversion from SG to Roux-en-Y gastric bypass (RYGBP) was performed to assess weight loss, diabetes resolution, and relief of ...
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#1Lionel RebiboH-Index: 18
#2David FuksH-Index: 37
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Longitudinal sleeve gastrectomy (LSG) has been validated for the treatment of morbid obesity. However, treatment failures can appear several months after SG. Additional malabsorptive surgery is generally recommended in such cases. The objective of the present study was to evaluate the outcomes of repeat SG (re-SG) relative to first-line SG. This was a retrospective study included 15 patients underwent re-SG after failure of first-line SG (i.e. University Hospital, France; Public Practice). These...
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#3Samer G. Mattar (IU: Indiana University)H-Index: 25
OBJECTIVES: In this study, we report long-term outcomes of high-risk, high-BMI (body mass index) patients who underwent laparoscopic sleeve gastrectomy (LSG). BACKGROUND: Short- and medium-term data appear to support the effectiveness of LSG, but long-term data to support its durability are sparse. METHODS: A prospective database was reviewed on all high-risk patients who underwent LSG as part of a staged approach for surgical treatment of severe obesity between January 2002 and February 2004. W...
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#1Antonio IannelliH-Index: 45
#2Anne-Sophie Schneck (University of Nice Sophia Antipolis)H-Index: 23
Last. Jean Gugenheim (University of Nice Sophia Antipolis)H-Index: 58
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Background Laparoscopic sleeve gastrectomy (LSG) has been rapidly accepted as a valuable bariatric procedure before its effectiveness on weight loss in the long-term is clearly demonstrated. We report a feasibility study including 13 patients undergoing a redo LSG for either progressive weight regain after initial weight loss of insufficient weight loss.
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#1Jacques HimpensH-Index: 49
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Objective:To determine the mid- and long-term efficacy and possible side effects of laparoscopic sleeve gastrectomy as treatment for morbid obesity.Summary Background Data:Laparoscopic sleeve gastrectomy is still controversial as single and final treatment for morbid obesity. Some favorable short-te
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Abstract Background Repeat sleeve gastrectomy (re-SG) and the addition of the duodenal switch (DS) are possible options to increase weight loss after isolated SG (ISG). We report the feasibility, safety, and outcomes of laparoscopic re-SG versus DS in patients presenting with insufficient weight loss or weight regain after ISG. Methods From November 2003 to December 2009, 7 and 19 patients underwent laparoscopic re-SG and DS, respectively, mainly because of the patients' dietary habits: volume e...
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#6Manish Parikh (Cornell University)H-Index: 14
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#2Arthur Bohdjalian (Medical University of Vienna)H-Index: 19
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Background Due to excellent weight loss success in the short-time follow-up, sleeve gastrectomy (SG) has gained popularity as sole and definitive bariatric procedure. In the long-term follow-up, weight loss failure and intractable severe reflux can necessitate further surgical intervention.
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