Laparoscopic conversion of failed gastric bypass to duodenal switch: technical considerations and preliminary outcomes
This study was presented at the 24th Annual Meeting of the American Society for Bariatric Surgery; June 11–16, 2007, San Diego, California.
Received 27 April 2007; received in revised form 26 June 2007; accepted 12 July 2007. published online 16 October 2007.
Abstract
Background
Weight loss failure after Roux-en-Y gastric bypass (RYGB) is a challenging problem facing bariatric surgeons today. Conversion from RYGB to biliopancreatic diversion with duodenal switch (BPD-DS) might provide the most durable weight loss of all revision procedures currently available. Revision to BPD-DS can be done laparoscopically in 1 or 2 stages and involves 4 anastomoses: gastrogastrostomy, duodenoileostomy, ileoileostomy, and jejunojejunostomy (to reconnect the old Roux limb). This study reports on our early outcomes after laparoscopic conversion from RYGB to BPD-DS.
Methods
The data from all patients undergoing conversion from failed RYGB to BPD-DS were retrospectively reviewed. The data analyzed included age, body mass index, excess weight loss, method of gastrogastrostomy, and morbidity/mortality.
Results
Twelve patients were identified for analysis. The mean age and body mass index before conversion was 41 years and 41 kg/m2, respectively. Of these 12 patients, 4 (33%) had undergone revision surgery (lengthening of the Roux limb, resizing the gastric pouch, adjustable band on pouch, or distal gastric bypass) before conversion; 8 (66%) had obesity-related co-morbidities; 7 (58%) underwent conversion to BPD-DS in 1 stage. Most gastrogastrostomies were performed using the 25-mm circular stapler. No patient died and no leaks developed. One patient required laparotomy, and 4 developed stricture at the gastrogastrostomy. The patients lost a dramatic amount of weight after conversion to BPD-DS, with a mean body mass index and excess weight loss of 31 kg/m2 and 63%, respectively, at 11 months postoperatively. All co-morbidities resolved completely with the weight loss.
Conclusion
Our preliminary results indicate that laparoscopic conversion to BPD-DS from failed RYGB is highly effective with an acceptable morbidity. Using a linear stapler to construct the gastrogastrostomy might reduce the stricture rate.
Laparoscopic and Bariatric Surgery, Department of Surgery, Joan and Sanford I. Weill College of Medicine of Cornell University, New York Presbyterian Hospital, New York, New York USA
Reprint requests: Michel Gagner, M.D., F.R.C.S.C., F.A.C.S., Laparoscopic and Bariatric Surgery, Department of Surgery, Joan and Sanford I. Weill Medical College of Cornell University, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, Box 294, NY, NY 10021.
ABSTRACT