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Thaher O, Daza JFM, Croner RS, Stroh C. Outcome of Revisional Bariatric Surgery After Failed Sleeve Gastrectomy: a German Multicenter Study. Obes Surg 2023; 33:3362-3372. [PMID: 37770775 DOI: 10.1007/s11695-023-06834-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/03/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023]
Abstract
PURPOSE Sleeve gastrectomy (SG) is a common bariatric procedure that has been shown to be effective in both the short and long term, but it is not without risks, some of which necessitate revision or redo surgery (RS). MATERIALS AND METHODS GBSR (German Bariatric Surgery Registry) data were evaluated in this multicenter analysis. Short-term results (1-year follow-up) of RS (Re-Sleeve gastrectomy, Roux-en-Y gastric bypass, RYGB, Omega-loop gastric bypass, OLGB, and duodenal switch, DS) following primary SG (n = 27939) were evaluated. RESULTS Of PSG patients, 7.9% (n=2195) needed revision surgery. Nine hundred ninety-four patients underwent the aforementioned four surgical procedures (95 with R-SG, 665 with RYGB, 141 with OLGB, and 93 DS). Loss of follow-up within 1 year 52.44%. The most common reasons for RS were weight regain and/or a worsening of preexisting comorbidities. Regarding the operating time, R-SG was the shortest of the four procedures, and DS was the longest. In general, there were no significant advantages of one procedure over another in terms of complication incidence in these categories. However, certain complications were seen more often after R-SG and DS than with other redo procedures. There were significant differences in BMI reduction 1 year after surgery (RYGB: 5.9; DS: 10.1; OLGB: 9.1; and R-SG: 9.1; p<0.001). GERD, hypertension, and sleep apnea demonstrated statistically significant comorbidity remission. Diabetes exhibited non-significant differences. CONCLUSION According to the findings of our study, all revision surgeries effectively resolved comorbidities, promoted weight loss, and lowered BMI. Due to the disparate outcomes obtained by various methods, this study cannot recommend a particular redo method as the gold standard. Selecting a procedure should consider the redo surgery's aims, the rationale for the revision, the patient's current state, and their medical history.
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Affiliation(s)
- Omar Thaher
- Department of Surgery, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Juan Fernando Mesa Daza
- Department of Surgery, Elisabeth Klinikum Schmalkalden GmbH, Eichelbach 9, 98574, Schmalkalden, Germany
| | - Roland S Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Christine Stroh
- Department of General, Abdominal and Pediatric Surgery, Municipal Hospital, Straße des Friedens 122, 07548, Gera, Germany.
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Fehervari M, Banh S, Varma P, Das B, Al-Yaqout K, Al-Sabah S, Khwaja H, Efthimiou E, Ashrafian H. Weight loss specific to indication, remission of diabetes, and short-term complications after sleeve gastrectomy conversion to Roux-en-Y gastric bypass: a systematic review and meta-analysis. Surg Obes Relat Dis 2023; 19:384-395. [PMID: 36581551 DOI: 10.1016/j.soard.2022.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/03/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022]
Abstract
Laparoscopic sleeve gastrectomy (SG) is the most frequently performed bariatric procedure worldwide. Long-term complications such as insufficient weight loss (IWL) and gastroesophageal reflux disease (GERD) may necessitate SG conversion to Roux-en-Y gastric bypass (RYGB). The aim of this review was to determine the indication-specific weight loss and diabetes remission after SG conversion to RYGB (STOBY). Our objective was to extract all available published data on indication for conversion, weight loss, remission of diabetes, and short-term complications after STOBY. A systematic literature search was conducted to identify studies reporting outcomes following STOBY. A random effects model was used for meta-analysis. The search identified 44 relevant studies. Overall short-term (12-mo) excess weight loss (EWL) was 54.6% (95% confidence interval [CI], 46%-63%) in 23 studies (n = 712) and total weight loss (TWL) was 19.9% (95% CI, 14%-25%) in 21 studies (n = 740). For IWL, short-term (12-mo) pooled weight loss outcomes were 53.9% EWL (95% CI, 48%-59%) in 14 studies (n = 295) and 22.7% TWL (95% CI, 17%-28%) in 12 studies (n = 219), and medium-term (2-5 yr) outcomes were 45.8% EWL (95% CI, 38%-53%) in 7 studies (n = 154) and 20.6% TWL (95% CI, 15%-26%) in 9 studies (n = 206). Overall diabetes remission was 53% (95% CI, 33%-72%), and the perioperative complication rate was 8.2% (95% CI, 7.6%-8.7%). Revisional SG conversion to RYGB for IWL can achieve good weight loss outcomes and diabetes remission.
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Affiliation(s)
- Matyas Fehervari
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, United Kingdom; Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
| | - Serena Banh
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Piyush Varma
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Bibek Das
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | | | - Haris Khwaja
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, United Kingdom; Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Nazari M, Jameson C, Ryan B, Brancatisano A. Efficacy and Safety of Sleeve Gastrectomy or One Anastomosis Gastric Bypass Conversion Following Adjustable Gastric Banding. Obes Surg 2023; 33:426-433. [PMID: 36480102 DOI: 10.1007/s11695-022-06374-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Given revision or conversion surgery is required in up to 60% of patients who had adjustable gastric band (LAGB), we compared safety and efficacy of sleeve gastrectomy (SG) and one anastomosis gastric bypass (OAGB) as conversion surgical procedures in patients with suboptimal response or weight recurrence following LAGB. METHODS Conversion surgery was performed in 335 patients between 2016 and 2020. Weight loss, early and late-stage complications, and comorbidity outcomes were reviewed and analyzed. RESULTS One hundred and sixty-three patients underwent cSG (BMI: 38.3 ± 8.3 kg/m2), and 172 patients underwent cOAGB (BMI: 45.2 ± 9.3 kg/m2). Percent total body weight loss (%TWL) was 28.7 ± 9.9% at 12 months, 30.3 ± 12.8% at 2 years, 31.0 ± 14.5% at 3 years, and 31.1 ± 14.7% at 4 years following OAGB, which was significantly higher than SG; 18.4 ± 8.7%, 18.8 ± 9.8%, 19.3 ± 11.1%, and 16.9 ± 10.9%, respectively (p < 0.0001). Remission of comorbidities, regardless of conversion procedure type, was 20.8% for hypertension (HT), 52% for dyslipidemia (DLD), 60% for type 2 diabetes (DM), 64% for non-alcoholic steatohepatitis (NASH), and 76% for insulin resistance (IR).There were no leaks or deaths following SG or OAGB. A twofold greater frequency of complications was seen in the OAGB group vs SG group (15.1% and 6.7%, respectively). CONCLUSION Significant weight loss, acceptable complication rates, and similar remission of comorbidities were seen regardless of the type of conversion procedure. Prospective randomized clinical trials are recommended for further elucidation of long-term outcomes.
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Affiliation(s)
- Mojgan Nazari
- Sydney Bariatric Clinic, Westmead, New South Wales, 2145, Australia. .,Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, 2145, Australia.
| | - Carolyn Jameson
- Sydney Bariatric Clinic, Westmead, New South Wales, 2145, Australia.,School of Medicine, University of Notre Dame, Darlinghurst, New South Wales, 2010, Australia
| | - Brendan Ryan
- Sydney Bariatric Clinic, Westmead, New South Wales, 2145, Australia
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Diaz Del Gobbo G, Mahmoud N, Barajas-Gamboa JS, Klingler M, Barrios P, Abril C, Raza J, Aminian A, Rosenthal RJ, Corcelles R, Kroh MD. Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass to Enhance Weight Loss: Single Enterprise Mid-Term Outcomes and Literature Review. Bariatr Surg Pract Patient Care 2022; 17:197-205. [PMID: 36636335 PMCID: PMC9807278 DOI: 10.1089/bari.2021.0096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Suboptimal weight loss (SWL) occurs up to 30% after sleeve gastrectomy (SG). Conversion to Roux-en-Y gastric bypass (cRYGB) has shown heterogeneous results in terms of additional weight loss and resolution of weight-related comorbidities. We aim to evaluate mid-term outcomes of cRYGB specifically for SWL after SG. Methods All patients who underwent cRYGB for SWL from April 2010 to June 2019 from prospective registries at three affiliated tertiary care centers were retrospectively reviewed. Patients who underwent revision or conversion for complications were excluded. Mixed-effects and polynomial regression models were used to evaluate weight loss results after conversion. Results Thirty-two patients underwent cRYGB from SG. About 68.7% were women with mean age of 46.6 years. Mean body mass index (BMI) before SG was 55.3 kg/m2. Before conversion, mean BMI was 44.5 kg/m2 with 17.3% total weight loss (TWL). All procedures were completed laparoscopically in a median surgical time of 183 min. Three major complications occurred (9.3%), one gastrojejunal (GJ) leak and two reoperations. Four cases (12.5%) of GJ stenosis were diagnosed. No mortality was registered. Mean follow-up time was 24 months and patients had 36 kg/m2 mean BMI, 17.4% TWL, 27.2% had BMI >35 kg/m2. Conclusions cRYGB after SG for SWL showed good mid-term results, better than those reported in literature.
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Affiliation(s)
- Gabriel Diaz Del Gobbo
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.,Address correspondence to: Gabriel Diaz Del Gobbo, MD, Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, 59 Hamouda Bin Ali Al Dhaheri Street, Abu Dhabi, PO Box 112412, United Arab Emirates
| | - Nada Mahmoud
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Juan S. Barajas-Gamboa
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Michael Klingler
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Paola Barrios
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Carlos Abril
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Javed Raza
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Ali Aminian
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.,Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Raul J. Rosenthal
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.,Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida, USA
| | - Ricard Corcelles
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Matthew D. Kroh
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.,Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Oyefule O, Do T, Karthikayen R, Portela R, Dayyeh BA, McKenzie T, Kellogg T, Ghanem OM. Secondary Bariatric Surgery-Does the Type of Index Procedure Affect Outcomes After Conversion? J Gastrointest Surg 2022; 26:1830-1837. [PMID: 35715643 DOI: 10.1007/s11605-022-05385-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/04/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although revisions account for 17% of cases performed at bariatric centers of excellence, scarce data exists on whether index operation type influences outcomes after secondary operations. OBJECTIVE We designed a study investigating the effect of primary procedure type on weight loss and perioperative complications after conversion bariatric surgery. SETTING Tertiary Referral Hospital, USA. METHODS We performed a retrospective review of patients undergoing conversion from sleeve gastrectomy (SG) or adjustable gastric band (AGB) to Roux-en-Y gastric bypass (RYGB) from 2009 to 2019. Post-operatively, we measured short- and medium-term complications and changes in body weight at various time points. Univariate and regression analyses were performed. RESULTS Forty-two (SG) patients and 116 (AGB) patients underwent conversion to RYGB, most commonly for GERD (57.1%) in SG patients vs. weight regain (77.6%) in AGB patients. Mean pre-conversion BMI was 36.7 kg/m2 (SG) vs 43.8 kg/m2 (AGB). Mean time to conversion (months) was 52.9 (SG) vs 94.7 (AGB). Complication rate was 9.5% (SG) vs 6% (AGB) at 30 days (p = 0.48) and 31%(SG) vs 14.5% (AGB) (p = 0.02) at 2 years. Mean post conversion %TWL was 11.6% (SG) vs 24.6% (AGB) in patients with GERD/dysphagia (p = 0.014) and 20.7% (SG) vs 27.6% (AGB) in patients converted for weight-related reasons (p = 0.027) at 1 year. Overall mean %TWL was 13.2% (SG) vs 24.7% (AGB) at 2 years (p < 0.0035). CONCLUSION After conversion to RYGB, patients with AGB experience better short- and medium-term weight loss than those with SG, even after accounting for conversion indications. SG to RYGB conversions have a higher resolution of reflux disease.
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Affiliation(s)
- Omobolanle Oyefule
- Department of Surgery, Emory University School of Medicine, 550 Peachtree Street NE, Atlanta, GA, 30308, USA
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Timothy Do
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Raveena Karthikayen
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ray Portela
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Barham Abu Dayyeh
- Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Travis McKenzie
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Todd Kellogg
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Nedelcu M, Noel P, Danan M, Vilallonga R, Zulian V, Nedelcu A, Carandina S. Revisional Surgery from Vertical Banded Gastroplasty to Roux-en-Y Gastric Bypass with Gastric Resection. J Laparoendosc Adv Surg Tech A 2021. [PMID: 34935465 DOI: 10.1089/lap.2021.0386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Vertical banded gastroplasty (VBG) was a common bariatric procedure by laparotomy and or at the beginning of the laparoscopy, but nowadays it is almost an abandoned procedure. However, the young generation of bariatric surgeons should be aware about this procedure especially for revisional cases. Roux-en-Y gastric bypass (RYGB) is considered the procedure of choice for the revision of VBG. Materials and Methods: The evolution of revisional surgery to RYGB has known several technical steps. At the beginning, the procedure was performed with no gastric resection. Then a limited resection of the ancient staple line along with the fibrous tissue under the previous band or mesh was performed. The purpose of this article is to describe a simplified operative technique to simultaneously resect the ancient staple line and the calibration band. Results: After the initial viscrerolysis, an attempt to distinguish the course of the ancient section line of the stomach during the VBG is done. The dissection can become extremely challenging, with too much fibrosis and nonanatomical planes of dissection. At this point, we counsel to abandon the anterior direct dissection of the upper part of the stomach and to switch to a posterior dissection with the approach of greater curvature. Driven by the potential advantages (no risk of mucocele or gastrogastric fistula), for the past several years, we have changed the technique from resecting only the ancient staple line to perform a partial gastrectomy. The gastrectomy is larger and includes the complete resection of the gastric fundus, ancient staple line, the region with the mesh inside, and part of the gastric body. Once the stomach is extracted, the subsequent steps are similar to those of a primary RYGB. Conclusion: The procedure of choice for the revision of VBG is represented by RYGBP. Associating an atypical gastrectomy of the previous staple line with the region of mesh migration is a safe approach, eliminating the risk of mucocele.
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Affiliation(s)
- Marius Nedelcu
- Department of General Surgery, Centre Chirurgical de l'Obesite, ELSAN, Clinique Saint Michel, Toulon, France
- Department of General Surgery, Clinique Bouchard, ELSAN, Marseille, France
| | - Patrick Noel
- Department of General Surgery, Clinique Bouchard, ELSAN, Marseille, France
- Department of General Surgery, Emirates Specialty Hospital, Dubai, United Arab Emirates
| | - Marc Danan
- Department of General Surgery, Centre Chirurgical de l'Obesite, ELSAN, Clinique Saint Michel, Toulon, France
| | - Ramon Vilallonga
- Department of General Surgery, Centre Chirurgical de l'Obesite, ELSAN, Clinique Saint Michel, Toulon, France
- Department of General Surgery, Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Hospital Vall d'Hebron, Barcelona, Spain
- Department of General Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Viola Zulian
- Department of General Surgery, Centre Chirurgical de l'Obesite, ELSAN, Clinique Saint Michel, Toulon, France
| | - Anamaria Nedelcu
- Department of General Surgery, Centre Chirurgical de l'Obesite, ELSAN, Clinique Saint Michel, Toulon, France
| | - Sergio Carandina
- Department of General Surgery, Centre Chirurgical de l'Obesite, ELSAN, Clinique Saint Michel, Toulon, France
- Department of Digestive and Bariatric Surgery, Clinica Madonna della Salute, Porto Viro, Italy
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