Outcomes of sleeve conversion to gastric bypass: preliminary results revisional surgery

Introduction: Laparoscopic sleeve gastrectomy (LSG) is the most performed bariatric procedures worldwide, representing over 50 % of the operations done annually in Italy, USA and France. Reported long-term results are still insufficient, with controversial data on percentage of failed sleeves. Conversion in gastric bypass (BPG) remains one of the options in case of failure or severe gastro-esophageal reflux disease (GERD), with or without hiatal hernia. Aims: to evaluate incidence, indications and outcomes of LSG conversion to GBP in a bariatric centre of excellence. Materials and methods: LSG was performed in 975 morbid obese patients between 2012 and 2016. Patients reoperated for insufficient weight loss (IWL), for weight regain (WR) or for GERD were retrospectively analysed for demographics, operative details, postoperative complications, GERD improvement, weight loss, reasons of failure and comorbidity evolution, for a follow-up of 2 years. Results: 14 patients (1.4%, 3M/11F, mean age 42.8 years, initial mean BMI 43.7 kg/m2) were converted to laparoscopic GBP after a mean period of 42.6 months. Causes of conversion were: IWL (7.1%), WR (28.5%) e MRGE (64,2%). Mean BMI at GBP time was 33.7 kg/m2, while 12 months after GBP was 29.2. Mean operative time was 150 ± 50 minutes, with a mean hospital stay of 5.2 ± 1.1 days. One anastomotic leak was registered (7,1%), in one patient with initial vertical gastroplasty converted to sleeve, reoperated for GERD 12 months lately, at a BMI of 25 kg/m2, with a prolonged hospital stay (90 days). Conclusions: conversion of LSG to GBP is safe and effectiveness during medium term for treatment of postoperative GERD, main cause of reoperation. Long-term follow-up is mandatory to confirm data on weight loss durability.