Conversions After Sleeve Gastrectomy for Weight Regain: to Single and Double Anastomosis Duodenal Switch and Gastric Bypass at a Single Institution.

Abstract

With the increase in popularity of laparoscopic sleeve gastrectomy (LSG), the number of patients experiencing weight regain has increased as well. This study aims to demonstrate the outcomes of LSG conversions to Roux-en-Y gastric bypass (RYGB), double anastomosis duodenal switch (DS), and single anastomosis duodeno-ileal sleeve (SADI-S) due to weight regain. A retrospective chart review was performed on 21 patients who underwent a conversion of LSG due to weight regain between March 1, 2013, and April 30, 2017. A longitudinal analysis was performed for the body mass index (BMI) measures, using multilevel model for change. Of 21 patients, 6 underwent a conversion to RYGB, 9 underwent a conversion to SADI-S, and 6 underwent a conversion to double anastomosis DS. Mean percentage of total weight loss was 16.0% at 6months, 20.1% at 12months, 18.8% at 24months, and 21.8% at 36months after the procedure. The final model suggests that preoperative BMI is the most significant indicator for initial status and the rate of change in BMI. Adjusting for preoperative BMI, type of procedure significantly affected the rate of change in BMI. The rate of decrease was fastest in RYGB patients, adjusting for preoperative BMI. One patient was readmitted 26days after the conversion for pulmonary embolism and intraabdominal hematoma, and no patient required a reoperation within 30days after the conversion. Conversions of LSG to RYGB, double anastomosis DS, and SADI-S are safe and can provide significant additional weight loss.