Short-term outcomes of sleeve gastrectomy conversion to R-Y gastric bypass: multi-center retrospective study

Introduction: The outcomes of failed laparoscopic sleeve gastrectomies (LSG) converted to laparoscopic standard R-Y gastric bypass (LRYGB) in case of insufficient weight loss (IWL), weight regain (WR), and/or severe gastro-esophageal reflux disease (GERD) are scanty. Purpose: To evaluate incidence, indications, and short-term outcomes of LSG conversion to LRYGB in three bariatric centers. Methods: Patients operated between January 2012 and December 2016 by primary LSG, with mean follow-up of 24 months and converted to LRYGB for IWL, WR, and/or GERD, were retrospectively analyzed for demographics, operative details, perioperative complications, comorbidities evolution, and further WL. Results: Thirty patients (2.76%, 7 M/23 F, mean age 41 ± 10.1 years, initial mean BMI 46.9 ± 6.3 kg/m2) were successfully converted after a mean period of 33 ± 27.8 months for severe GERD (15 patients, 50%), GERD and IWL/WR (3 patients, 10%), and IWL/WR (12 patients, 40%). Surgical complications occurred in three patients (10%). Mean BMI at revision time was 36 ± 9 kg/m2, and 30.8 ± 5.2, 28 ± 4.9, and 28 ± 4.3 kg/m2after 6, 12, and 24 months, respectively. Resolution of GERD was achieved in 83% of cases. Overall, postoperative satisfaction was reported by 96% of the cases, after mean follow-up of 24 ± 8.9 months. Conclusions: In high-volume centers, where strict criteria for patients’ selection for LSG are applied, the expected incidence of reoperations for “non-responder” (IWL/WR) or de novo or persistent severe GERD non-responder to medical treatment is low (< 3%). Conversion of “non-responder” LSG to LRYGB is effective for further WL and GERD remission at short term (2 years follow-up); however, a high postoperative complication rate was observed. Long-term multidisciplinary follow-up is mandatory to confirm data on WL durability and comorbidity control.