Advertisement

Conversion of gastric sleeve to Roux-en-Y gastric bypass: overall outcomes and predictors of below-average weight loss

Published:November 07, 2022DOI:https://doi.org/10.1016/j.soard.2022.10.029

      Highlights

      • Sixty-two patients underwent sleeve to bypass conversion with weight loss as a goal
      • The average percent excess weight loss was 41.5% at one year and 30.8% at two years
      • Interval to conversion < 2 years and BMI > 40 were predictors of below-average %EWL
      • Sleeve to bypass conversion is effective for weight loss in select patients

      Abstract

      Background

      Conversion of sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB) has been utilized to promote further weight loss, but results are variable in available literature.

      Objectives

      To evaluate outcomes of SG to RYGB conversion for weight loss and to identify predictors of below-average weight loss.

      Setting

      University-affiliated hospital, United States.

      Methods

      Chart review was performed of our patients who underwent SG to RYGB conversion from November 1, 2013, to November 1, 2020. Primary outcomes were below-average percent excess weight loss (%EWL) at 1 and 2 years. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for preconversion demographics to evaluate their relationship to the primary outcome.

      Results

      Sixty-two patients underwent conversion from SG to RYGB with weight loss as a goal. One-year data was available for 47 patients. The average %EWL at 1 year was 41.5%. Twenty-six patients had below-average %EWL at 1 year. Interval to conversion <2 years (OR = 4.41, 95% CI [1.28,15.17], P = .019) and preconversion body mass index (BMI) >40 (OR = 4.00, 95% CI [1.17,13.73], P = .028) were statistically significant predictors of below-average 1-year %EWL. Two-year data was available for 36 patients. The average %EWL at 2 years was 30.8%. Seventeen patients had below-average %EWL at 2 years. Evaluated demographics were not statistically significant predictors of below-average 2-year %EWL.

      Conclusions

      Following SG to RYGB conversion, %EWL outcomes are lower at 1 year (41.5%) and 2 years (30.8%) than reported values for primary RYGB. Interval to conversion <2 years and preconversion BMI >40 are predictors of below-average 1-year weight loss after conversion.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Surgery for Obesity and Related Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Arterburn D.E.
        • Telem D.A.
        • Kushner R.F.
        • Courcoulas A.P.
        Benefits and risks of bariatric surgery in adults: a review.
        JAMA. 2020; 324: 879-887
        • Emile S.H.
        • Elfeki H.
        • Elalfy K.
        • Abdallah E.
        Laparoscopic sleeve gastrectomy then and now: an updated systematic review of the progress and short-term outcomes over the last 5 years.
        Surg Laparosc Endosc Percutaneous Tech. 2017; 27: 307-317
        • Wang F.G.
        • Yu Z.P.
        • Yan W.M.
        • Yan M.
        • Song M.M.
        Comparison of safety and effectiveness between laparoscopic mini-gastric bypass and laparoscopic sleeve gastrectomy: a meta-analysis and systematic review.
        Medicine (Baltimore). 2017; 96e8924
        • Zhang C.
        • Yuan Y.
        • Qiu C.
        • Zhang W.
        A meta-analysis of 2-year effect after surgery: laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for morbid obesity and diabetes mellitus.
        Obes Surg. 2014; 24: 1528-1535
        • Salminen P.
        • Helmio M.
        • Ovaska J.
        • et al.
        Effect of laparoscopic sleeve gastrectomy vs laparoscopic roux-en-y gastric bypass onweight loss at 5 years among patients with morbid obesity the SLEEVEPASS randomized clinical trial.
        JAMA. 2018; 319: 241-254
        • Osland E.J.
        • Yunus R.M.
        • Khan S.
        • Memon M.A.
        Five-year weight loss outcomes in laparoscopic vertical sleeve gastrectomy (LVSG) versus laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures: a systematic review and meta-analysis of randomized controlled trials.
        Surg Laparosc Endosc Percutaneous Tech. 2020; 30: 542-553
        • Gu L.
        • Huang X.
        • Li S.
        • et al.
        A meta-analysis of the medium- and long-term effects of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass.
        BMC Surg. 2020; 20: 30
        • Cheung D.
        • Switzer N.J.
        • Gill R.S.
        • Shi X.
        • Karmali S.
        Revisional bariatric surgery following failed primary laparoscopic sleeve gastrectomy: a systematic review.
        Obes Surg. 2014; 24: 1757-1763
        • Dapri G.
        • Cadire G.B.
        • Himpens J.
        Laparoscopic repeat sleeve gastrectomy versus duodenal switch after isolated sleeve gastrectomy for obesity.
        Surg Obes Relat Dis. 2011; 7: 38-43
        • Homan J.
        • Betzel B.
        • Aarts E.O.
        • Van Laarhoven K.J.H.M.
        • Janssen I.M.C.
        • Berends F.J.
        Secondary surgery after sleeve gastrectomy: Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch.
        Surg Obes Relat Dis. 2015; 11: 771-777
        • Biertho L.
        • Thériault C.
        • Bouvet L.
        • et al.
        Second-stage duodenal switch for sleeve gastrectomy failure: a matched controlled trial.
        Surg Obes Relat Dis. 2018; 14: 1570-1579
        • Aiolfi A.
        • Micheletto G.
        • Marin J.
        • Bonitta G.
        • Lesti G.
        • Bona D.
        Resleeve for failed laparoscopic sleeve gastrectomy: systematic review and meta-analysis.
        Surg Obes Relat Dis. 2020; 16: 1383-1391
        • Landreneau J.P.
        • Strong A.T.
        • Rodriguez J.H.
        • et al.
        Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass.
        Obes Surg. 2018; 28: 3843-3850
        • van Wezenbeek M.R.
        • van Oudheusden T.R.
        • de Zoete J.P.J.G.M.
        • Smulders J.F.
        • Nienhuijs S.W.
        Conversion to gastric bypass after either failed gastric band or failed sleeve gastrectomy.
        Obes Surg. 2017; 27: 83-89
        • Haldane J.B.S.
        The exact value of the moments of the distribution of χ2, used as a test of goodness of fit, when expectations are small.
        Biometrika. 1939; 31: 220
        • Anscombe F.J.
        On estimating binomial response relations.
        Biometrika. 1956; 43: 461-464
        • Sheskin D.J.
        Handbook of parametric and nonparametric statistical procedures. 3rd ed. 46. Chapman & Hall/CRC, Boca Raton2004
        • Karamanakos S.N.
        • Vagenas K.
        • Kalfarentzos F.
        • Alexandrides T.K.
        Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-yy levels after roux-en-y gastric bypass and sleeve gastrectomy a prospective, double blind study.
        Ann Surg. 2008; 247: 401-407
        • Uhe I.
        • Douissard J.
        • Podetta M.
        • et al.
        Roux-en-Y gastric bypass, sleeve gastrectomy, or one-anastomosis gastric bypass? A systematic review and meta-analysis of randomized-controlled trials.
        Obesity. 2022; 30: 614-627
        • Zhang Y.
        • Zhao H.
        • Cao Z.
        • et al.
        A randomized clinical trial of laparoscopic roux-en-y gastric bypass and sleeve gastrectomy for the treatment of morbid obesity in china: a 5-year outcome.
        Obes Surg. 2014; 24: 1617-1624
        • Tang Q.
        • Sun Z.
        • Zhang N.
        • et al.
        Cost-effectiveness of bariatric surgery for type 2 diabetes mellitus.
        Medicine (Baltimore). 2016; 95e3522
        • Matar R.
        • Monzer N.
        • Jaruvongvanich V.
        • et al.
        Indications and outcomes of conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: a systematic review and a meta-analysis.
        Obes Surg. 2021; 31: 3936-3946
        • Casillas R.A.
        • Um S.S.
        • Zelada Getty J.L.
        • Sachs S.
        • Kim B.B.
        Revision of primary sleeve gastrectomy to Roux-en-Y gastric bypass: indications and outcomes from a high-volume center.
        Surg Obes Relat Dis. 2016; 12: 1817-1825
        • Poghosyan T.
        • Lazzati A.
        • Moszkowicz D.
        • et al.
        Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: an audit of 34 patients.
        Surg Obes Relat Dis. 2016; 12: 1646-1651
        • Cummings D.E.
        • Overduin J.
        • Foster-Schubert K.E.
        Gastric bypass for obesity: mechanisms of weight loss and diabetes resolution.
        J Clin Endocrinol Metab. 2004; 89: 2608-2615
        • Cesana G.
        • Uccelli M.
        • Ciccarese F.
        • Carrieri D.
        • Castello G.
        • Olmi S.
        Laparoscopic re-sleeve gastrectomy as a treatment of weight regain after sleeve gastrectomy.
        World J Gastrointest Surg. 2014; 6: 101-106
        • Piche T.
        Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery.
        Nutr Clin Metab. 2002; 16: 219-220
        • Tritos N.A.
        • Mun E.
        • Bertkau A.
        • Grayson R.
        • Maratos-Flier E.
        • Goldfine A.
        Serum ghrelin levels in response to glucose load in obese subjects post-gastric bypass surgery.
        Obes Res. 2003; 11: 919-924
        • Stoeckli R.
        • Clianda R.
        • Langer I.
        • Keller U.
        Changes of body weight and plasma ghrelin levels after gastric banding and gastric bypass.
        Obes Res. 2004; 12: 346-350
        • McCarty T.R.
        • Jirapinyo P.
        • Thompson C.C.
        Effect of sleeve gastrectomy on ghrelin, GLP-1, PYY, and GIP gut hormones: a systematic review and meta-analysis.
        Ann Surg. 2020; 272: 72-80
        • Yu Y.
        • Klem M Lou
        • Kalarchian M.A.
        • Ji M.
        • Burke L.E.
        Predictors of weight regain after sleeve gastrectomy: an integrative review.
        Surg Obes Relat Dis. 2019; 15: 995-1005
        • Herpertz S.
        • Kielmann R.
        • Wolf A.M.
        • Hebebrand J.
        • Senf W.
        Do psychosocial variables predict weight loss or mental health after obesity surgery? A systematic review.
        Obes Res. 2004; 12: 1554-1569
        • Moon R.C.
        • Nelson L.
        • Teixeira A.F.
        • Jawad M.A.
        Outcomes of Roux-en-Y gastric bypass in the super obese: comparison of body mass index 50-60 kg/m2 and≥60 kg/m2 with the morbidly obese.
        Surg Obes Relat Dis. 2016; 12: 292-296
        • Gould J.C.
        • Garren M.J.
        • Boll V.
        • Starling J.R.
        Laparoscopic gastric bypass: risks vs. benefits up to two years following surgery in super-super obese patients.
        Surgery. 2006; 140: 524-531
        • Thereaux J.
        • Czernichow S.
        • Corigliano N.
        • Poitou C.
        • Oppert J.M.
        • Bouillot J.L.
        Five-year outcomes of gastric bypass for super-super-obesity (BMI≥60 kg/m): a case matched study.
        Surg Obes Relat Dis. 2015; 11: 32-37
        • Aly A.
        • Mori K.
        Laparoscopic Roux en Y gastric bypass in the super obese.
        Ann Transl Med. 2020; 8: S6
        • Yoshikawa I.
        • Nagato M.
        • Yamasaki M.
        • Kume K.
        • Otsuki M.
        Long-term treatment with proton pump inhibitor is associated with undesired weight gain.
        World J Gastroenterol. 2009; 15: 4794-4798
        • Czwornog J.L.
        • Austin G.L.
        Association of proton pump inhibitor (PPI) use with energy intake, physical activity, and weight gain.
        Nutrients. 2015; 7: 8592-8601
        • Parmar C.D.
        • Mahawar K.K.
        • Boyle M.
        • Schroeder N.
        • Balupuri S.
        • Small P.K.
        Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass is effective for gastro-oesophageal reflux disease but not for further weight loss.
        Obes Surg. 2017; 27: 1651-1658