IBC-Oxford University2023_BJSOral_12Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass: Indications, Management and Results

Abstract

Abstract Introduction Sleeve gastrectomy (SG) represents more than 60% of bariatric procedures worldwide. Conversion of SG to Roux-en-Y gastric bypass (RYGB) for weight loss failure (WLF) or gastro-oesophageal reflux disease (GERD) is increasing. Intrathoracic migration of the sleeve often seems associated. Aim The aim of our study was to analyse the relevance of the indications, the prevalence of an associated de novo hiatal hernia, and the outcomes of the conversion of SG to RYGB. Methods This is a retrospective study of prospectively collected data including all the patients who underwent a conversion of SG to RYGB from August 2013 to December 2022. 2 groups were compared: patients operated on because of weight loss failure (WLF group) and those operated on for GERD (GERD group). Results We analysed in both groups demographic data, the incidence of an associated hiatal hernia, morbidity, weight loss outcomes and resolution of symptoms. 59 patients were included with an average follow-up of 30.5 months: 46 patients in the GERD group (78%) were compared to 13 patients (22%) in the WLF group. Groups were comparable regarding age (47) and gender (women: 74%); BMI at conversion and prevalence of comorbidities were significantly higher in the WLF group (41.8 kg/m² vs 33.3, p=0.0001). In the GERD group: on preoperative gastroscopy, 30% (14/46) had a grade B esophagitis, 48% (22/46) had a significant hiatal hernia which required a posterior crural closure versus 23% (3/13) in the WLF group, not requiring a surgical treatment (p = 0.02). Conversion was very effective on GERD symptoms (93% of improvement), 52% of the patients stopped proton pump inhibitor treatment. In the WLF group, mean percentage total weight loss (% TWL) was 15.3%, significantly greater than in the GERD group (% TWL=4.6%, p = 0.01). The complication rate was 10% at 30 days and 3.4% after 30 days, not significantly different between groups (p = 1 and 1 respectively). Conclusions The main indication of conversion of SG to RYGB was because of GERD: in these indications, the incidence of intrathoracic migration of the sleeve is high requiring a surgical treatment with a very good efficacy on resolution of symptoms. Weight loss results were disappointing.